Claims Examiner
Claim processor job in Massachusetts
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.
Auto-ApplyCasualty Claim Examiner
Claim processor job in Boston, MA
Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs.
Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district.
Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!
Claims Examiner
Claim processor job in Washington, MA
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.
Auto-ApplyClaims Manager II, Hospital Professional Liability
Claim processor job in Boston, MA
Ready to lead and shape Hospital Professional Liability claims strategy? Apply to this senior-level claims leader position, Claims Manager II.
Join a high-performing team leading the Hospital Professional Liability claims unit for IronHealth/NAS Claims. We're looking for a seasoned Claims Manager with deep Hospital Professional Liability experience who wants to lead a technical team, shape claims strategy, and drive measurable improvements across a portfolio of complex and high-severity matters consistent with the standards of Liberty International Underwriters.
*This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. This policy is subject to change.
The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, and the overall cost of labor for that region, and based on you location you may not qualify for the top salary listed in the range.
Responsibilities
Responsible for performance, development and coaching of staff (including hiring, terminating, performance and salary management). Serve as technical resource not only for claims staff, but also cross-functional partners, including Underwriting (UW), Actuarial, Finance and Operations.
Work with claims team and external attorneys to review coverages, investigate claims, analyze liability and damages, establish adequate indemnity and expense reserves, develop strategies and resolve claims, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions.
Perform quality assurance reviews/observations and provide feedback to team as well as action plan for development of team, where necessary.
Actively pursue all avenues of recovery including, but not limited to timely recovery of deductibles from insureds and manage subrogation activities.
Provide regular reports to claims management regarding losses either exceeding or likely to exceed the authority level in accordance with best practices. Must be able to present effectively, produce appropriate reports and develop team and train team in these skills
Partner with underwriting managers/team to provide excellent customer service and to market and meet with brokers, risk managers and reinsurers. Serve as external face claims leader for product line and demonstrate ability to forge and maintain relationships with external customers, effectively resolving concerns where necessary. Ability to effectively articulate the claims value proposition in claims advocacy meetings, account renewals and new business prospecting. Present at industry conferences or publishes external industry content.
Lead short to medium-term strategic claims activities/priorities for the product line, with alignment with the strategic priorities of IronHealth and NAS Claims. Oversee projects assigned by the department head.
Direct and manage the Claims participation and content for multidisciplinary reviews, monthly UW connectivity meetings, and quarterly actuarial meetings. Ensure timely feedback to senior management, underwriting and actuaries regarding relevant losses, account issues, and trends.
Assist and coordinate with underwriting team regarding new policy forms, product development and/or product rollouts and provide timely feedback to senior management and underwriting regarding recommendations.
Ability to achieve fluency in Loss Triangle interpretation and Product Level Profitability Understanding/Awareness.
Other duties as assigned, including delivery on established operational goals and objectives.
Qualifications
Qualifications - what will make you successful!
Bachelors' degree or equivalent training; advanced degrees or certifications preferred.
A minimum of 8+ years of relevant and progressively more responsible work experience required, including at least 2 years of supervisory experience.
At least 5 years claims handling within a technical specialty. Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace.
Requires advanced knowledge of a technical specialty. Knowledge of law and insurance regulations in various jurisdictions.
The ability to effectively interact with brokers and internal departments is also required. Strong verbal and written communications and organizational skills.
Strong negotiation, analytical and decision-making skills also required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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Auto-ApplyWorkers Compensation Claims Specialist, East
Claim processor job in Boston, MA
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:
* Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
* Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
* Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.
* Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
* Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
* Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
* Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
* Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
* Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
* Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
* May serve as a mentor/coach to less experienced claim professionals
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
* Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
* Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
* Demonstrated ability to develop collaborative business relationships with internal and external work partners.
* Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
* Demonstrated investigative experience with an analytical mindset and critical thinking skills.
* Strong work ethic, with demonstrated time management and organizational skills.
* Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
* Developing ability to negotiate low to moderately complex settlements.
* Adaptable to a changing environment.
* Knowledge of Microsoft Office Suite and ability to learn business-related software.
* Demonstrated ability to value diverse opinions and ideas
Education & Experience:
* Bachelor's Degree or equivalent experience.
* Typically a minimum four years of relevant experience, preferably in claim handling.
* Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
* Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
* Professional designations are a plus (e.g. CPCU)
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
Auto-ApplyBenefit and Claims Analyst
Claim processor job in Boston, MA
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
Insurance Claim Analyst
Claim processor job in Hingham, MA
About us
Talbots is a leading omni-channel specialty retailer of women's clothing, shoes and accessories. Established in 1947, we are known for modern classic style that's both timeless and timely, fine quality craftsmanship and gracious service. At Talbots relationships are the key to our business, we hire individuals who bring new ideas to the table, understand smart risk taking and can enhance an already thriving culture. With a commitment to offer modern classic style for every body type, through a full range of sizes, inclusive to every woman in your life.
Insurance Claim Analyst - KnitWell Group
About the role
Working as part of an integrated strategic claims oversight team, this position is responsible for administering the Company's casualty claims processes (workers comp, general liability & auto), while assisting in the identification and assessment of related exposures/risks.
The impact you can have
Operational effectiveness of claims process and strategy across workers comp, general liability and auto claims.
Develop and maintain strong partnerships with peers across the organization and primary contact for internal and external contacts on all casualty claims.
Recommend and help to maintain day-to-day claim processes that drive Insurer/TPA performance.
Monitors compliance with company policy regarding loss-reporting and claim handling standards and works collectively with Asset Protection to identify non-compliant reporting trends and drive improved reporting across field, DC and office locations.
Monitors all open claims for proper reserving and adjuster performance and assist the Sr. Mgr. of Claims with achieving optimal claim service deliverables and working claims toward final resolution.
Monitors claim frequency and/or severity within locations and communicates concerns across the Insurance, Store Facilities and Asset Protection Teams.
Assist Mgr of Occ Health with the tracking and documentation of disability periods associated with workers comp claims in the internal rmis system.
Assist with tracking and documentation of information required for the Y/E Dept of Labor/Osha recordkeeping process.
Track and document litigation data in rmis system.
Provides back-up to Sr. Claim Manager on all claim related invoicing.
Performs with an eye toward timeliness and sense of urgency. Adapts well to and initiates change.
You'll bring to the role
Experience in the insurance industry as an adjuster or in a corporate insurance capacity a plus
Strong written and oral communication skills necessary
Proficient in Excel
Knowledge of Oracle and SAP a plus
Knowledge of insurance or workers comp terminology and concepts a plus
Benefits
You will be eligible to receive a merchandise discount at select KnitWell Group brands, subject to each brand's discount policies.
Support for your individual development plus opportunities for career mobility within our family of brands.
A culture of giving back - local volunteer opportunities, annual donation and volunteer match to eligible nonprofit organizations, and philanthropic activities to support our communities.*
Medical, dental, vision insurance & 401(K).*
Employee Assistance Program (EAP).
Time off - paid time off & holidays.*
The target salary range for this role is: $67,000 - 75,000*
*Any job offer will consider factors such your qualifications, relevant experience, and skills. Eligibility of certain benefits and associate programs are subject to employment type and role.
This position works in a hybrid model, with required days worked in the Talbots office location in Hingham, MA as defined by business needs.
Applicants to this position must be authorized to work for any employer in the US without sponsorship. We are not providing sponsorship for this position.
#LI-MJ1
Location:
Hingham Corporate OfficePosition Type:Regular/Full time
Equal Employment Opportunity
The Company is an equal opportunity employer and welcomes applications from diverse candidates. Hiring decisions are based upon a candidate's qualifications as they relate to the requirements of the position under consideration and are made without regard to sex (including pregnancy), race, color, national origin, religion, age, disability, genetic information, military status, sexual orientation, gender identity, or any other category protected by applicable law. The Company is committed to providing reasonable accommodations for job applicants with disabilities. If you require an accommodation to perform the essential duties of the position you are seeking or to participate in the application process, please contact my ***************************. The Company will make reasonable accommodations for otherwise qualified applicants or employees, unless such accommodations would impose an undue hardship on the operations of the Company's business. The Company will not revoke or alter a job offer based on an applicant's request for reasonable accommodation.
Auto-ApplyOutside Property Claim Representative
Claim processor job in East Bridgewater, MA
**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**
$52,600.00 - $86,800.00
**Target Openings**
1
**What Is the Opportunity?**
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. 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. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in South Eastern MA. The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory.
Experienced candidates will also be considered.
**What Will You Do?**
+ Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
+ The on the job training includes practice and execution of the following core assignments:
+ Handles 1st party property claims of moderate severity and complexity as assigned.
+ Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
+ Broad scale use of innovative technologies.
+ Investigates and evaluates all relevant facts to determine coverage (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 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 attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
+ 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.
+ In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
+ This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. 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 preferred or a minimum of two years of work OR customer service related experience.
+ Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic.
+ Verbal and written communication skills -Intermediate.
+ Attention to detail ensuring accuracy - Basic.
+ Ability to work in a high volume, fast paced environment managing multiple priorities - Basic.
+ Analytical Thinking - Basic.
+ Judgment/ Decision Making - Basic.
+ Valid passport.
**What is a Must Have?**
+ High School Diploma or GED and one year of customer service experience OR Bachelor's Degree.
+ 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 ******************************************************** .
Claims Specialist - Massachusetts
Claim processor job in Massachusetts
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Receives claims, confirms policy coverage and acknowledgment of the claim
Determines validity and compensability of the claim
Establishes reserves and authorizes payments within reserving authority limits
Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision
Communicates claim status with the customer, claimant and client
Adheres to client and carrier guidelines and participates in claims review as needed
Assists other claims professionals with more complex or problematic claims as necessary
Additional duties as assigned
KNOWLEDGE & SKILLS:
Excellent written and verbal communication skills
Ability to learn rapidly to develop knowledge and understanding of claims practice
Ability to identify, analyze and solve problems
Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
Strong interpersonal, time management and organizational skills
Ability to meet or exceed performance competencies
Ability to work both independently and within a team environment
EDUCATION & EXPERIENCE:
Bachelor's degree or a combination of education and related experience
Minimum of 1 year of industry experience and claims management preferred
State Certification as an Experienced Examiner
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $51,807 - $83,551
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Stop Loss & Health Claim Analyst
Claim processor job in Wellesley, MA
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
Auto-ApplyClaims Analyst
Claim processor job in Chelmsford, MA
Van Pool Transportation LLCHeadquartered in Massachusetts, Beacon Mobility is a growing family of companies committed to serving the diverse needs of our customers. Experienced, compassionate, and inspired, we take pride in our ability to create customized, mobility-based solutions that empower people to get where they need to go. Our purpose is simple - MOBILITY WITHOUT LIMITS: Transporting people to live, learn, and achieve. We provide those we serve with the opportunities, resources, and support to confidently move ahead.
Description
Headquartered in Massachusetts, Beacon Mobility is a growing family of companies committed to serving the diverse needs of our customers. Experienced, compassionate, and inspired, we take pride in our ability to create customized, mobility-based solutions that empower people to get where they need to go. Our purpose is simple - MOBILITY WITHOUT LIMITS: Transporting people to live, learn, and achieve. We provide those we serve with the opportunities, resources, and support to confidently move ahead.
We support safe, compassionate, and inclusive environments that provide our communities with the mobility solutions they need to flourish and succeed. Providing support to 13,000 employees through more than 500 contracts, we collectively deliver Paratransit and School Bus services with a fleet of 13,000+ vehicles at 200+ locations from New England to New Mexico.
Reporting to the Director of Claims, the Region Claims Analyst provides oversight and controls to reporting and management of crash and injury events across all locations within a region. This position is responsible for utilizing company defined reporting processes, KPI's and predictive analytics tools to ensure appropriate shareholders are aware of the opportunities to improve or sustain results.
The role will require highly effective communication, motivation and project management skills while delivering analytical support to operations, safety and claims leadership. Support to locations will require compliance with applicable company practices, governmental reporting regulations, and contractual requirements.
The candidate for this role requires successful experience in managing complex data systems. Our ideal candidate will be flexible and result-oriented with a track record of continually inspiring shareholders buy in. Achieving that end will also require the ability to proactively analyze current processes/procedures and appropriately challenge colleagues and leadership as needed to build continued process improvement and reliable safety practices.
Primary Responsibilities:
Reporting process oversight -
Support and oversee timely crash and injury event reporting:
Training safety directors on intake process/portal
Communicating outlier reporting to safety directors for correction or process modelling
Propose resource or process modification to drive accuracy and efficiency
Ensure event coding accuracy
- Review and correct event coding and details to achieve:
Timely actionable performance metrics
Efficient claims mitigation
Efficient recovery opportunities
Claims administration support/oversight
- maintain command of claims within prescribed values to:
Drive employee injury and return to work awareness - who, what needed, when
Ensure TPA and operations awareness of critical elements and drive claims closure
Ensure TPA and operations awareness of physical damage/subrogation events and values
Significant Event & Crisis Support
- Provides immediate and ongoing support to regional operations staff with crash/injury crisis response and investigations.
Provide crisis response support with deploying investigators and conducting an initial review of the loss prior to Sedgwick submission/intervention.
Communicate potential indicators which affect values (i.e.: venue, questionable damage, questionable video, questionable liability).
Communicate significant events claims progression (i.e.: safety, operations, external counsel, executive team).
Interdepartmental Communication
- Establishes and maintains effective business relationships with internal teams, TPA's, and underwriters/brokers.
Qualification Requirements:
Bachelor's degree in business administration or risk management; or evidence of equivalent experience specifically around critical thinking, leading investigations and verbal & written communication skill development
Broad understanding of safety policies and transportation best practices
Excellent written and verbal communication skills.
Ability to travel up to 25% of the time within the assigned Region, with periodic outside of the assigned region travel (as needed)
Preferred qualifications:
Demonstrate competency in the areas of research methodologies, project management and contract administration
Advanced knowledge of Microsoft Office software (Word, Excel, Outlook, PowerPoint, etc.) and transportation related software and telematics
Terms of acceptance:
Upon acceptance of an offer of employment, employee will perform services for Beacon Mobility that may require Beacon Mobility to disclose confidential and proprietary information ("Confidential Information") to Employee. (Confidential Information is information and data of any kind concerning any matters affecting or relating to Beacon mobility, the business or operations of Beacon Mobility, and/or the products, drawings, plans, processes, or other data of Beacon Mobility not generally known or available outside of the company.)
Employee will hold the Confidential Information received from Beacon Mobility in strict confidence and will exercise a reasonable degree of care to prevent disclosure to others and will not disclose or divulge either directly or indirectly the Confidential Information to others unless first authorized to do so in writing by Beacon Mobility management.
All provisions of this agreement will be applicable only to the extent that they do not violate any applicable law and are intended to be limited to the extent necessary so that they will not render this agreement invalid, illegal or unenforceable. If any provision of this agreement or any application thereof will be held to be invalid, illegal or unenforceable, the validity, legality and enforceability of other provisions of this agreement or of any other application of such provision will in no way be affected thereby.
Beacon Mobility is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Beacon Mobility makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Auto-ApplySenior Claim Benefit Specialist
Claim processor job in Boston, MA
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems.
+ Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.
+ Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.
+ Performs claim re-work calculations.
+ Follow through completion of claim overpayments, underpayments, and any other irregularities.
+ Process complex non-routine Provider Refunds and Returned Checks.
+ Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks.
+ Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
+ Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures.
+ Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.
+ May provide job shadowing to lesser experience staff.
+ Utilize all resource materials to manage job responsibilities.
**Required Qualifications**
+ 2+ years medical claim processing experience.
+ Experience in a production environment.
+ Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
+ Effective communications, organizational, and interpersonal skills.
**Preferred Qualifications**
+ DG system claims processing experience.
+ Associate degree preferred.
**Education**
+ High School Diploma or GED.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$18.50 - $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit *****************************************
We anticipate the application window for this opening will close on: 12/23/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Epic Professional Billing Claims Analyst III
Claim processor job in Boston, MA
Title: Epic Professional Billing Claims Analyst III Reports to: Manager of Professional Billing and Claims Classification: Individual Contributor Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices nationally. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
The Professional Billing Claims Analyst III position will be housed under a subsidiary organization of C3, Community Technology Cooperative, LLC (CTC). To implement, maintain, support, and maximize the use of clinical, financial, and administrative portions of the software applications utilized by CTC in conducting daily operations under the direction of the Manager of Professional Billing and Claims.
Responsibilities:
* Maintaining current clinical, financial, and administrative applications, implementing new clinical, financial, and administrative applications
* Assisting in the assessment of workflow processes and assisting in process re-engineering to achieve efficiencies in departmental operations
* Assisting users in developing reports and analyses, troubleshooting, and resolution of application issues
* Working with the IT Education staff to assist in training users and in the development of documentation
* Maintaining a level of knowledge about IT operations and network issues and maintaining current industry knowledge
* Ability to maintain current system applications
* Facilitate end users' ability to understand and maximize the use of the software to perform daily operations
* Evaluate user knowledge and work with IT education staff to develop specialized training when necessary; educate users in system optimization
* Acts as liaison between users and the software vendor(s)
Guides the modification of system applications in instances where current applications impede performance or where changes will enhance performance
* Ensure system application updates are working properly before updates are loaded into the live system by coordinating testing and update dates with users and vendors
* Integrate new application(s) in the existing HIS according to the implementation schedule
* Respond to user questions with timely answers and/or referral to appropriate department/person
* Assist users with technical problems by alerting HIS Operations staff to the need for repair or investigation
* Coordinate with Database Analysts to provide expertise in the development of reports and analyses
* Work with other IT staff to ensure interfaces between applications and systems are functioning properly
* Maintain and periodically review dictionaries, assist in entering and maintaining user codes, maintain the security of applications, and ensure consistency between various dictionaries
* Investigate on timely basis discrepancies in statistics which could indicate a problem with the accuracy of data
Work with application managers, staff from affected areas, and representatives from other impacted areas, to analyze computer system functions and compare data and existing systems both functionally and procedurally
* Implement new clinical, financial, and administrative software, including add-on features, and/or new routines in existing applications
* Participates with other IT staff and other clinical, financial, and administrative areas in the planning and implementation stages of the application, including the development of dictionaries
* Work with Department Managers and IT Education staff to ensure training programs for use of applications are developed and conducted for all levels of users and participate in such programs when needed
* Develop system documentation to supplement vendor manuals and which defines processes, procedures, and policies regarding utilization of various functions
* Assist departments with the development of downtime procedures
* Work with Operation Manager and staff to establish schedules for report production and system jobs to maintain balanced system utilization and minimize system degradation, if necessary
* Sustain working knowledge of key functions of all aspects of the department in order to provide emergency coverage in the absence of others in the department
* Work with Applications Manager to accomplish other departmental tasks
* Notify the Applications Manager of requests for custom modifications to standard applications and of any updates to standard systems which replace existing custom modifications so that the Application Manager can take appropriate action
* Assist in the development of IT policies and procedures and notify users as appropriate
* Participate in applications on-call rotation for the information system
* Participate in workgroups and committees as necessary
* Demonstrates competent and effective job performance skills as evidenced by the volume, skill, and technical knowledge of work performed, neatness, accuracy, thoroughness, and completeness, and the ability to follow instructions
* Strong attention to detail
* Ability to manage multiple priorities in an effective and organized manner
* Demonstrates the ability to interact effectively and in a professional manner with peers
* Administration, and other customers as demonstrated by willingness to work with others to achieve CTC's goals
* Ability to present a friendly and positive manner, willingness to seek additional tasks
* Responsibility to assist the department and/or peers, ability to be flexible and perform new tasks and adjust to change even under pressure
* Ability to accomplish results by working effectively with or through other people
* Ability to hear and communicate with others in a clear, understandable, and professional manner in person and on the phone
* Ability and commitment to provide outstanding customer service
* Ability to actively listen, demonstrate patience and empathy, and authentically engage with individuals in a caring and helpful manner
* Ability to identify and resolve problems and maintain composure and sound judgment in difficult or stressful situations
* Maintain current industry knowledge by attending industry seminars, reviewing professional literature, and communicating on a regular basis with other IT analysts
* Required to travel onsite for site visits and project milestones either at the health center or the CTC office in Boston
* Other duties as assigned
Required Skills:
* Ability to understand, analyze, document, and explain business processes and the data that underly them
* Experience working with Electronic Health Records, medical claims, and other health care data
* Experience working with Clearinghouses to facilitate claims transmission
* Subject Matter Expert in claims area of Epic software
* Flexible and adaptable to change in a fast-paced environment
* Demonstrated ability to work both independently and as part of a team
* Demonstrated ability to thrive in a fast-past environment
* Nuanced interpersonal communication skills
* Minimum experience of having participated in at least one Epic implementation
Desired Other Skills:
* Familiarity with the MassHealth ACO program
* Familiarity with Federally Qualified Health Centers
* Experience working in a provider organization
* Experience working in a managed care environment
* Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
* Bachelor's degree in a healthcare-related field, Information Systems or Business Management
* Resolute Professional Billing Claims Administration (required)
* Resolute Professional Billing Electronic Remittance (required)
* Epic Resolute Professional Billing SBO Certification (preferred)
* Minimum of three years' experience as a certified Epic analyst
In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.
Medicare/Medicaid Claims Editing Specialist
Claim processor job in Boston, MA
011250 CCA-Claims
Hiring for One Year Term
This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time.
Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits. This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and research, as necessary on all new and revised coding logic, related Medicare/Medicaid policies for review/approval through the Payment Integrity governance process.
Supervision Exercised:
No, this position does not have direct reports.
Essential Duties & Responsibilities:
Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration requirements for Optum CES and Zelis edits.
Quarterly and Annual review and research, as necessary on all new CPT and HCPCS codes for coding logic, related Medicare/Medicaid policies to make recommend reimbursement determinations.
Analyze, measure, manage, and report outcome results on edits implemented.
Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to industry standard coding regulations, and make recommendations based on new/revised coding edits for presentation to Payment Integrity committee meetings.
Analyze, measure, manage, and report outcome results on edits implemented.
Use and maintain the rules and policies specific to CES and Zelis.
Query and analyze claims to address any negative editing impacts and create new opportunities for savings based on provider billing trends
Liaison between business partners and vendors; bringing and interpreting business requests, providing solutioning options and documentation, developing new policies based on State and Federal requirements, host meetings, and managing projects to completion
Define business requests received, narrow the scope of the request based on business needs and requirements, provider resolution option based on financial ability and forecasting for small to large Operations Management
Collaborate system and data configuration into CES (Claims Editing System) with BPaaS vendor and other PI partners, perform user acceptance testing, and analyze post production reports for issues
Support collaboration between PI/Claims and other internal stakeholders related to the identification and implementation of cost-savings initiatives specific to edits.
Working Conditions:
Standard office conditions. Remote opportunity.
Other:
Standard office equipment
None/stationary
Required Education (must have):
Bachelor's Degree or Equivalent experience
Ideal Candidate to have the one or all of the required certification OR willing to get certified within 1 year of employment -
Certified Professional Coder (CPC)
Certified Inpatient Coder (CIC)
Certified Professional Medical Auditor (CPMA)
Desired Education (nice to have):
Masters Degree
Required Experience (must have):
7+ years of Healthcare experience, specific to Medicare and Medicaid
7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required
7+ years experience with Optum Claims Editing System (CES), Zelis, Lyric or other editing tools
Extensive knowledge and experience in Healthcare Revenue Integrity, Payment Integrity, and Analytics
5+ years of Facets Claims Processing System
Required Knowledge, Skills & Abilities (must have):
Knowledge and experience of claim operations, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare)
Medical Coding, Compliance, Payment Integrity and Analytics
Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies (i.e . Center for Medicare & Medicaid Services (CMS) & MA Medicaid, Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) both practitioner and facility, modifier to procedure validation, and other CMS and American Medical Association (AMA) guidelines, etc.)
Advanced experience of medical terminology and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims' processing policies, coding principals and payment methodologies
Ability to work cross functionally to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives
Ability to plan, organize, and manage own work; set priorities and measure performance against established benchmarks
Ability to communicate and work effectively at multiple levels within the company
Customer service orientation; positive outlook, self-motivated and able to motivate others
Strong work ethic; able to solve problems and overcome challenges
Required Language (must have):
English
Compensation Range/Target: $64,000 - $96,000
Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Auto-ApplyEmployment Practice Liability Claim Manager
Claim processor job in Boston, MA
Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims.
JD preferred with good interpersonal skills.
Call for additional details.
Disability Claims Specialist - Pittsfield, MA
Claim processor job in Pittsfield, MA
At Guardian, we live our Purpose every day. As champions of wellbeing for ourselves, our communities, and consumers, we focus as a team to turn what's possible into a reality. We create experiences for you to grow and enrich your career and future as a Disability Claims Specialist. We believe in your aspirations for purpose, leadership, and achievement in your professional and personal lives.
We will help build the core competencies you will need to be a successful Disability Claims Specialist. In your first year, we will provide extensive training in a highly supportive environment.
If you have an internal drive to investigate using your critical thinking skills assessing policy matters and can manage competing priorities while meeting deadlines, this is your opportunity to make a difference, grow your career, and be a part of moving the organization into the future.
**In the role, you will**
+ Analyze policy language, medical, financial, and other claim documentation.
+ Apply critical thinking, investigative, and problem-solving skills to make objective claims decisions.
+ Demonstrate resourcefulness in navigating complex situations and utilizing available tools, systems, and information to find thoughtful, effective solutions.
+ Ability to communicate effectively and professionally in writing with a variety of audiences including customers, as well as medical, financial, legal resources, and other key stakeholders.
+ Engage in extensive phone communication with customers; comfort and professionalism in live conversations is essential. Phone interactions are the primary mode of customer contact.
+ Work independently with self-motivation while embracing collaboration when needed.
+ Maintain composure and direction in high pressure situations.
+ Utilize communication skills to meet the customer's needs, while demonstrating empathy, flexibility, responsiveness, and an action-oriented approach.
+ Be expected to travel to meet with customers in-person.
**You have**
+ Bachelor's degree or high school diploma with equivalent work experience.
+ Demonstrate strong verbal skills for real-time conversations and equally strong written skills for clear, concise, and professional correspondence.
+ Intrinsically motivated with a strong sense of accountability.
+ Desire to engage customers with a solution-oriented mindset.
+ Strong analytical skills, with attention to detail.
+ Ability to navigate multiple systems, resources, and information streams simultaneously.
+ Experience with prioritizing with competing deadlines.
+ Desire to grow and develop professionally through continuous learning and feedback.
**Location**
The primary office location for this position is Pittsfield, MA with occasional travel to meet business needs.
**Salary Range:**
$41,880.00 - $62,820.00
The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.
**Our Promise**
At Guardian, you'll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
**Inspire Well-Being**
As part of Guardian's Purpose - to inspire well-being - we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at *********************************************** . _Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits._
**Equal Employment Opportunity**
Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
**Accommodations**
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact *************. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.
**Visa Sponsorship**
Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant. you must be legally authorized to work in the United States, without the need for employer sponsorship.
**Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.**
Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being - mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .
Visa Sponsorship:
Guardian Life is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship.
Claims Auditor I, II & Senior
Claim processor job in Boston, MA
**Claims Auditor I, II and Senior** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
_Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._
The **Claims Auditor I** is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers.
The **Claims Auditor II** is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance.
The **Claims Auditor Senior** is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit.
**How you will make an impact :**
+ Performs audits of high dollar claims.
+ Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity.
+ Contacts others to obtain any necessary information.
+ Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis.
+ Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable.
+ Refers overpayment opportunities to Recovery Team.
+ **Claims Auditor II** - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines.
+ **Claims Auditor Senior** - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills.
**Minimum Requirements :**
+ **Claims Auditor I :** Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background.
+ **Claims Auditor II :** Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
+ **Claims Auditor Senior :** Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
**Preferred Skills, Capabilities & Experiences:**
+ Stop loss claims experience highly preferred.
+ Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.
+ Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.
+ Strong research and problem solving skills preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is :
Claims Auditor I $21.41 to $38.88/hr
Claims Auditor II $22.54 to $40.94/hr
Claims Auditor Senior $25.69 to $46.64/hr
Locations: Illinois, Massachusetts, Minnesota, Washington State
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Senior Claims Auditor, Medical Stop Loss
Claim processor job in Boston, MA
Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.
We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world?
Learn more about our unique culture and history.
Job Opportunity:
Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss Senior Claims Auditor with knowledge of employer group health insurance, managed care, and direct medical claims products. This position will work with our Third-Party Administrator's (TPA's) daily with interaction with several other areas in our Medical Stop-Loss Division. The position is preferably located in our Indianapolis or Plymouth Meeting, PA office. We are open to candidates who could work from out Atlanta or Boston office as well.
Duties & Responsibilities:
Audit specific and aggregate claims for assigned complex blocks of business
Audit and process claim reimbursements
Verify claims are paid in accordance with the plan document and reimbursable under the Stop Loss policy
Verify participant and dependent eligibility
Maintain and exceed targeted claims accuracy standards
Maintain accurate and detailed information for each file
Conduct implementation calls for newly sold groups
Review and approve plan documents and plan amendments
Initiate and further cost containment opportunities
Audit program business claims across several lines within our Accident & Health Division
Assist management with implementation calls for new business sold
Set and adjust reserves
Qualifications, Skills, and Experience:
Minimum of 5+ years' experience examining and auditing medical stop loss claims
Proficient with Microsoft Office Suite, especially Excel
Knowledge of group insurance, managed care, and direct medical claims products
Demonstrate excellent mathematical, communication and customer service skills
Excellent problem-solving and critical-thinking skills
Detail/results-oriented
Strong analytical skills
Excellent customer service
Knowledge of COB, Medicare, HIPAA, CPT, ICD9/ICD10, and interpretation of employer group health plan benefits
Ability to work independently with minimal supervision while meeting or exceeding established turn-around-time, production, and accuracy standards
BHSI Offers:
A competitive package and exciting growth opportunities for career-oriented teammates
A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders
A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework
Benefits that support your life and well-being, which include:
Comprehensive Health, Dental and Vision benefits
Disability Insurance (both short-term and long-term)
Life Insurance (for you and your family)
Accidental Death & Dismemberment Insurance (for you and your family)
Flexible Spending Accounts
Health Reimbursement Account
Employee Assistance Program
Retirement Savings 401(k) Plan with Company Match
Generous holiday and Paid Time Off
Tuition Reimbursement
Paid Parental Leave
NOTE: This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization.
The base salary range for this position is from $70,000 - $80,000 along with annual bonus eligibility; a candidate's actual salary is commensurate with experience as determined by their relevant skills, experience, and geographical location. We value our teammates - both their capabilities and character - as demonstrated by our amazing culture.
Disability Claims Specialist - Pittsfield, MA
Claim processor job in Pittsfield, MA
At Guardian, we live our Purpose every day. As champions of wellbeing for ourselves, our communities, and consumers, we focus as a team to turn what's possible into a reality. We create experiences for you to grow and enrich your career and future as a Disability Claims Specialist. We believe in your aspirations for purpose, leadership, and achievement in your professional and personal lives.
We will help build the core competencies you will need to be a successful Disability Claims Specialist. In your first year, we will provide extensive training in a highly supportive environment.
If you have an internal drive to investigate using your critical thinking skills assessing policy matters and can manage competing priorities while meeting deadlines, this is your opportunity to make a difference, grow your career, and be a part of moving the organization into the future.
In the role, you will
Analyze policy language, medical, financial, and other claim documentation.
Apply critical thinking, investigative, and problem-solving skills to make objective claims decisions.
Demonstrate resourcefulness in navigating complex situations and utilizing available tools, systems, and information to find thoughtful, effective solutions.
Ability to communicate effectively and professionally in writing with a variety of audiences including customers, as well as medical, financial, legal resources, and other key stakeholders.
Engage in extensive phone communication with customers; comfort and professionalism in live conversations is essential. Phone interactions are the primary mode of customer contact.
Work independently with self-motivation while embracing collaboration when needed.
Maintain composure and direction in high pressure situations.
Utilize communication skills to meet the customer's needs, while demonstrating empathy, flexibility, responsiveness, and an action-oriented approach.
Be expected to travel to meet with customers in-person.
You have
Bachelor's degree or high school diploma with equivalent work experience.
Demonstrate strong verbal skills for real-time conversations and equally strong written skills for clear, concise, and professional correspondence.
Intrinsically motivated with a strong sense of accountability.
Desire to engage customers with a solution-oriented mindset.
Strong analytical skills, with attention to detail.
Ability to navigate multiple systems, resources, and information streams simultaneously.
Experience with prioritizing with competing deadlines.
Desire to grow and develop professionally through continuous learning and feedback.
Location
The primary office location for this position is Pittsfield, MA with occasional travel to meet business needs.
Salary Range:
$41,880.00 - $62,820.00
The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.
Our Promise
At Guardian, you'll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
Inspire Well-Being
As part of Guardian's Purpose - to inspire well-being - we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at ************************************************
Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.
Equal Employment Opportunity
Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
Accommodations
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact *************. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.
Visa Sponsorship
Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant. you must be legally authorized to work in the United States, without the need for employer sponsorship.
Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.
Auto-ApplyComplex Claims Specialist - Cyber, Technology, Media & Crime
Claim processor job in Boston, MA
Job Type:
Permanent
Build a brilliant future with Hiscox
Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist!
Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations:
West Hartford, CT (preferred)
Atlanta, GA
Boston, MA
Chicago, IL
Los Angeles, CA
Manhattan, NY
About the Hiscox Claims team:
The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners.
The role:
The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible.
What you'll be doing as the Complex Claims Specialist:
Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to:
Reviewing and analyzing claim documentation and legal filings
Drafting coverage analyses for tech E&O, first and third party cyber claims
Strategizing and maximizing early resolution opportunities
Monitoring litigation and managing local defense and breach counsel
Attending mediations and/or settlement conferences, either in person or by phone as appropriate
Smartly managing and tracking third-party vendor and service provider spend
Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
Liaising directly on daily basis with insureds and brokers
Maintaining timely and accurate file documentation/information in our claims management system
Our must-haves:
5+ years of professional lines claims handling experience
A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience
A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Advanced knowledge of coverage within the team's specialty or focus
Advanced knowledge of litigation process and negotiation skills
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred
What Hiscox USA Offers
Competitive salary and bonus (based on personal & company performance)
Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care)
Company paid group term life, short-term disability and long-term disability coverage
401(k) with competitive company matching
24 Paid time off days with 2 Hiscox Days
10 Paid Holidays plus 1 paid floating holiday
Ability to purchase 5 additional PTO days
Paid parental leave
4 week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox USA
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range $140,000 - $155,000 (Boston, Manhattan, West Hartford)
Salary range $125,000-$135,000 (Chicago, Atlanta)
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-AJ1
Work with amazing people and be part of a unique culture
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