Claim processor jobs in Nevada

Job Responsibilities: Assist with the setup of new workers' compensation claims Request information from providers, injured employees, and insureds via phone, email, fax, and, mail Handle inbound and outbound telephone calls to obtain pertinent medical and claim information Create and distribute claim forms and correspondence Process work assignments timely while adhering to Service Level Agreement parameters established by company policies and procedures Perform mathematical calculations to process appropriate payments to claimants, providers, and third-party vendors Job Requirements: High School diploma or GED equivalent Proficient in MS Office software, including Word, Outlook, and Excel

Workers' Compensation Claim Supervisor Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 adjusters Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a Workers' Compensation Claim Supervisor with California jurisdiction expertise to remotely lead a team of adjusters out of our Las Vegas, NV branch. This role is critical in ensuring claims are handled accurately, efficiently, and in compliance with client and regulatory requirements. You'll provide clear guidance and direction throughout the lifecycle of each claim, while mentoring and developing your team for long-term success. Responsibilities • Oversee proper handling of WC claims to protect the interests of the adjuster, client, and carrier • Review claim files regularly and provide direction on complex or litigated matters • Assist with reserve accuracy and compliance with client handling instructions • Participate in claim reviews and ensure adherence to jurisdictional laws and best practices • Recruit, train, and mentor staff; conduct performance reviews and manage PIPs • Address personnel issues and manage administrative responsibilities • Ensure compliance with carrier/state reporting requirements Qualifications What You'll Bring Required: • 10+ years of WC claims experience (California jurisdiction) • Prior experience adjusting WC claims from start to resolution • CA SIP designation or CA Claims Certificate (or ability to obtain within 60 days) • Strong leadership, communication, and organizational skills Preferred: • 3+ years of supervisory experience • Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required. • Proficiency in Microsoft Office and claims systems Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

Join an amazing team that is consistently recognized for our achievements and culture, including our most recent Forbes award of being one of America's Best Midsize Employers for 2025! If you're passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors. The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers. Geo-Salary Information An in-person interview may be required during the hiring process State specific pay scales for this role are as follows: $68,141 to $119,013 (NV, OR, AZ, CO, WY, TX, ND, MN, MO, IL, WI, FL, GA, MI, OH, VA, PA, DE, VT, NH, ME) The expected base salary for this position will vary depending on a number of factors, including relevant experience, skills and location. Responsibilities Essential Job Functions: * Investigate and resolve Homeowners claims of moderate complexity in a timely and efficient manner. Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes. * Ability to perform field inspections at least 50% of work time. (company car provided) This will involve travelling to our customers' home to conduct on-site inspections, thoroughly investigate coverage and prepare detailed estimate to efficiently resolve their claims. * Ability to handle virtual claims. Must have ability to use imagery, and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting when needed. * Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate. * Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval. * Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction. This includes timely response to phone calls, emails, texts, written communication, and adherence to Department of Insurance requirements. * Prioritizes own responsibilities and effectively manages claims workload to regularly monitor progress and expenses to properly resolve inventory to conclusion. * At times may direct, monitor, and review files handled by independent adjusters to conclusion. * Other functions may be assigned Qualifications Education: * Bachelor's degree preferred or equivalent combination of education and experience. * Valid driver's license is required. * Ability to obtain state specific property claims licensing, as required. * Must successfully participate and complete formal property claims training program that may take place in person, virtually, or a combination of both. Experience: * Have prior experience using estimating software like Xactimate. * Experience in a related field: property claims experience, customer service environment, construction, restoration, mitigation * Are known for clear and professional communication, both written and verbal * Are bilingual and/or have prior military experience is a plus * 3-5+ years equivalent industry experience is preferred Knowledge and Skills: As a Property Claims Field Adjuster 2, you will: * Possess the ability to work independently with limited or no supervision over daily activities required to successfully investigate, evaluate, write damage estimates, negotiate, and resolve property claims * Have a passion for outstanding customer service * Make quality decisions based upon a mixture of analysis, wisdom, experience, and judgment, including the ability to negotiate. * Be comfortable with and adaptable to new technology and business tools * Be able to seamlessly transition between various methods of inspection, including physical, video, or photo, to write a damage estimate: o May include climbing ladders to inspect roofing or attic space and inspection of crawl spaces. o Ability to lift and carry up to 50 pounds. * Possess strong organizational, time management, and prioritization skills to handle varying workloads due to seasonal volume changes and catastrophes. * Be able and willing to work flexible work shifts and may be asked to work overtime, as needs arise. * Drive to and from multiple locations and occasionally outside of normal business hours. About the Company Why choose a career at Mercury? At Mercury, we have been guided by our purpose to help people reduce risk and overcome unexpected events for more than 60 years. We are one team with a common goal to help others. Everyone needs insurance and we can't imagine a world without it. Our team will encourage you to grow, make time to have fun, and work together to make great things happen. We embrace the strengths and values of each team member. We believe in having diverse perspectives where everyone is included, to serve customers from all walks of life. We care about our people, and we mean it. We reward our talented professionals with a competitive salary, bonus potential, and a variety of benefits to help our team members reach their health, retirement, and professional goals. Learn more about us here: ********************************************** Perks and Benefits We offer many great benefits, including: * Competitive compensation * Flexibility to work from anywhere in the United States for most positions * Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours) * Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus) * Medical, dental, vision, life, and pet insurance * 401 (k) retirement savings plan with company match * Engaging work environment * Promotional opportunities * Education assistance * Professional and personal development opportunities * Company recognition program * Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more Mercury Insurance is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by federal, state, or local law. Pay Range USD $74,955.00 - USD $130,915.00 /Yr.

Job Description When life gets hard, we make it easier! Libra Solutions helps overcome the burdens created by slow-moving legal processes. Combining technical innovation and financial strength, we help speed cumbersome workflows and ease financial barriers for our customers. And our companies are leaders in their industries! Oasis Financial is the largest and most recognized national brand in consumer legal funding. Oasis helps consumers awaiting legal settlements to move forward with their lives. MoveDocs is a personal injury solutions platform that integrates and streamlines medical, financial, and professional services for personal injury cases. Our mission is to improve outcomes for plaintiffs, accelerate settlements for attorneys, and ensure timely payment for providers. We are proud of our mission and passionate about applying technology to the challenge of making healthcare more accessible. We also are the leading inheritance funding provider through Probate Advance, helping heirs access their inheritance immediately, without the lengthy process of probate. Together, under the Libra Solutions banner, we have relationships with over 40,000 attorneys and over 7,000 healthcare providers nationwide, which gives us an amazing platform to service our customers. MoveDocs is seeking a Claims Specialist to join our growing Operations team. The successful candidate will be highly motivated to deliver exceptional customer service to various parties within the medical and legal community. This position will function as the primary point of communication with our clients to stay up to date on existing cases and answer client questions. MoveDocs takes pride in providing excellent and expedient service to our clients and the qualified candidate must be self-motivated, able to work autonomously and enjoy working in a fast-paced, high-volume environment. This role is in office in our Las Vegas office. Answers high volume of inbound calls from insurance companies, attorneys, clients and/or medical providers daily Statuses cases to get updates on pending and ongoing case litigation and/or medical treatment. Drafts correspondence to defense insurance companies and/or attorneys including demand letters, emails, and faxes Delivers customer satisfaction through timely, accurate communications Develops rapport with the attorneys, firms, insurance companies and medical providers Requirements High School or GED required Experience in a high-volume call environment preferred Knowledge or experience with personal injury, medical billing, or claims a plus Previous claims and/or personal injury case manager experience preferred Self-motivated with desire to build great relationships, and to meet and exceed goals Ability to multitask while on the phone and the computer is a must Able to adapt to change and pivot easily between tasks Ability to work quickly and accurately to meet tight deadlines Possess excellent verbal and written communication skills for communicating with insurance companies, attorneys, and medical providers Basic computer proficiency and Outlook experience Benefits MoveDocs offers competitive compensation, benefits that include medical, dental, vision and life insurance plans, plus 401(k) with company match and paid time off.

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be the acknowledged technical expert and be responsible for the resolution of high complexity and high exposure claims. The position will have significant responsibility for decision making and work autonomously within their authority. Responsibilities: * High complexity coverage interpretation, liability investigation, multiple vehicles, potential extra-contractual, litigation or significant injuries. * Direct involvement in litigation claims management to reach desired outcomes and minimize expenses * Investigate, negotiate and settle complex liability cases. Maintain and make sure alignment to Markel's guidelines and procedures. * Ensure proper adherence to internal large loss reporting requirements. * Promptly communicate with Claims Manager on case developments and provide information on issues affecting the lines of business * Chip in and assist in the implementation of a range of initiatives, discussion and action plans brought forth by the Claims Manager * Connect with underwriting as needed to handle claims and to alert of any significant developments * Participate in agent related functions and meetings as required Requirements: * 7-10+ years of Liability claims handling experience with a commercial insurance company * Successful Liability claim handling experience is critical * College degree and/or professional designation preferred * Sound comprehension of personal and commercial liability coverages. * Excellent written and oral communication skills. * Experience in resolving contractual obligations, coverage analyses, and investigations. * Ability to run sophisticated large liability exposures, set loss and expense reserves and evaluate settlement values. * Ability to proactively self-manage an active caseload. * Ability to analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form. * Travel required as necessary (less than 15%). * Adjuster license in multiple states or across the US strongly preferred. US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Pay information: The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $97,520 - $134,000 with a 25% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

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 2 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. 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 preferred. * 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 preferred. What is a Must Have? * High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. * Valid driver's license - required. 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 *********************************************************

Full-time Description Workers' Compensation Claims Specialist Join GGRM Law Firm, Nevada's premier injury law firm in Las Vegas, NV, as a Workers' Compensation Claims Specialist and make a significant impact on the lives of those who have been injured. If you enjoy interacting with clients and are committed to providing excellent and compassionate representation, we invite you to join our team. For over 50 years, GGRM Law Firm has been a cornerstone of the Las Vegas community, dedicated to serving injured Nevadans by achieving maximum recovery and restoration. Being an employee at GGRM means being part of a supportive and team-oriented workplace where your contributions are valued and your professional growth is encouraged. We provide a flexible schedule that allows employees to choose their arrival time within a two-hour window, supporting a balance of personal and professional commitments. Join us and help continue our proud tradition of excellent service to our community. Position Summary A Workers' Compensation Claims Specialist is the primary point of contact for all issues involving claim management, providing a range of legal support to the Workers' Compensation Attorney. Salary Range $48,000 - $72,000 base, depending on experience Essential Duties and Responsibilities The essential functions include, but are not limited to, the following: Processing assigned claims in accordance with Firm policies and procedures Ensuring case management software (CMS) feed is cleared daily Completing all assigned tasks by relevant deadlines Documenting all relevant activity in CMS properly Ensuring emails are cleared daily Completing monthly Meaningful Client Communication (MCC) and serving as the primary point of contact for the client on claim management and litigation issues Communicating with insurance adjusters, third party administrators, medical providers, and other relevant parties as directed by the assigned attorney Meeting with the assigned attorney on a regular basis to ensure each claim is reviewed at least once per month Meeting with the assigned Attorney on a regular basis to assist with issues in litigation Working with the client and the assigned attorney to identify and address any issues that arise Training Claims Specialists as assigned Performing other duties as assigned Requirements High school diploma or equivalent Minimum of six months of workers' compensation claims experience or other related claims experience Thorough knowledge of legal principles, legal research techniques, legal terminology, and government regulations Excellent oral and written communication skills Excellent interpersonal, analytical, and critical thinking skills Proficient with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook Ability to operate basic office equipment such as a copy machine, fax machine, printer, scanner, computer Ability to work with databases and online technological platforms Ability to be detail-oriented, diligent, and flexible Ability to handle conflicting time demands and focus on task completion with little direction or need for supervisory follow-up Proficient command of the English language in both oral and written format Ability to work and maintain patience with diversified individuals of various backgrounds and professional competencies Committed to maintaining integrity and confidentiality on behalf of clients and the Firm Preferred Qualifications Associates Degree or Certificate program in Legal Studies Bilingual in English and Spanish Authorized Nevada Notary GGRM Law Firm provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Liability Claims Examiner - Auto & GL Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS Hybrid (2 Days In-Office) PRIMARY PURPOSE: To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Analyzes and processes complex or technically difficult general liability and auto liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. * Assesses liability and resolves claims within evaluation. * Negotiates settlement of claims within designated authority. * Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. * Prepares necessary state fillings within statutory limits. * Manages the litigation process; ensures timely and cost effective claims resolution. * Coordinates vendor referrals for additional investigation and/or litigation management. * Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. * Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. * Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. * Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. * Ensures claim files are properly documented and claims coding is correct. * Refers cases as appropriate to supervisor and management. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge * Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Good interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Service Expectations TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000 - $90,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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.

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$94,400.00 - $155,800.00Target Openings1What Is the Opportunity?This role is eligible for a sign-on bonus of up to $20,000. This position is hybrid (3 days in office, 2 days remote). Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.What Will You Do? Directly handles assigned severity claims. Provides quality customer service and ensures file quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. Consults with Manager on use of Claim Coverage Counsel as needed. Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. Complete outside investigation as needed per case specifics. Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. Maintains claim files and documents claim file activities in accordance with established procedures. Utilizes evaluation documentation tools in accordance with department guidelines. Proactively reviews Claim File Analysis (CFA) for adherence to quality standards and trend analysis. Utilizes diary management system to ensure that all claims are handled timely. Establishes and maintains proper indemnity and expense reserves. Recommends appropriate cases for discussion at roundtable. Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. Develops and employ creative resolution strategies. Responsible for prompt and proper disposition of all claims within delegated authority. Negotiates disposition of claims with insureds and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, Tracks and controls legal expenses to assure cost-effective resolution. Effectively and efficiently manages both allocated and unallocated loss adjustment expenses. Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options. Recognizes cases, based on severity/complexity protocols that should be transferred to another level of claim professional and refers on a timely basis. Appropriately deals with information that is considered personal and confidential. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions and inquiries from agents and brokers. Represents the company as a technical resource, attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws. Actively provides mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength. Shares accountability with business partners to achieve and sustain quality results. Evaluates all claims for recovery potential; directly handles recovery efforts and/or engages and directs Company resources for recovery efforts. 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. Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree. 4 years bodily injury litigation claim handling experience. Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. Able to make independent decisions on most assigned cases without involvement of supervisor. Thorough understanding of business line products, policy language, exclusions, ISO forms, and effective claims handling practices. Openness to the ideas and expertise of others actively solicits input and shares ideas. Strong customer service skills. - Intermediate. Demonstrated coaching, influence and persuasion skills.- Intermediate. Strong written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.- Intermediate. Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. - Intermediate. Attention to detail ensuring accuracy -Intermediate. Job Specific Technical Competencies: Analytical Thinking - Intermediate. Judgment/Decision Making - Intermediate. Communication - Intermediate. Negotiation -Advanced. Insurance Contract. Knowledge - Advanced. Principles of Investigation - Advanced. Value Determination - Advanced. Settlement Techniques - Intermediate. Legal Knowledge - Intermediate. Medical Knowledge - Intermediate. What is a Must Have? High School Degree or GED required with a minimum of 3 years bodily injury litigation claim handling or comparable claim litigation experience. 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 *********************************************************

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. 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. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $94,400.00 - $155,800.00 What Is the Opportunity? This role is eligible for a sign-on bonus of up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. What Will You Do? Directly handles assigned severity claims. Provides quality customer service and ensures file quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. Consults with Manager on use of Claim Coverage Counsel as needed. Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. Complete outside investigation as needed per case specifics. Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. Maintains claim files and documents claim file activities in accordance with established procedures. Utilizes evaluation documentation tools in accordance with department guidelines. Proactively reviews Claim File Analysis (CFA) for adherence to quality standards and trend analysis. Utilizes diary management system to ensure that all claims are handled timely. Establishes and maintains proper indemnity and expense reserves. Recommends appropriate cases for discussion at roundtable. Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. Develops and employ creative resolution strategies. Responsible for prompt and proper disposition of all claims within delegated authority. Negotiates disposition of claims with insureds and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, Tracks and controls legal expenses to assure cost-effective resolution. Effectively and efficiently manages both allocated and unallocated loss adjustment expenses. Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options. Recognizes cases, based on severity/complexity protocols that should be transferred to another level of claim professional and refers on a timely basis. Appropriately deals with information that is considered personal and confidential. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions and inquiries from agents and brokers. Represents the company as a technical resource, attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws. Actively provides mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength. Shares accountability with business partners to achieve and sustain quality results. Evaluates all claims for recovery potential; directly handles recovery efforts and/or engages and directs Company resources for recovery efforts. 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. Perform other duties as assigned. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's Degree. 4 years bodily injury litigation claim handling experience. Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. Able to make independent decisions on most assigned cases without involvement of supervisor. Thorough understanding of business line products, policy language, exclusions, ISO forms, and effective claims handling practices. Openness to the ideas and expertise of others actively solicits input and shares ideas. Strong customer service skills. - Intermediate. Demonstrated coaching, influence and persuasion skills.- Intermediate. Strong written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.- Intermediate. Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. - Intermediate. Attention to detail ensuring accuracy -Intermediate. Job Specific Technical Competencies: Analytical Thinking - Intermediate. Judgment/Decision Making - Intermediate. Communication - Intermediate. Negotiation -Advanced. Insurance Contract. Knowledge - Advanced. Principles of Investigation - Advanced. Value Determination - Advanced. Settlement Techniques - Intermediate. Legal Knowledge - Intermediate. Medical Knowledge - Intermediate. What is a Must Have? High School Degree or GED required with a minimum of 3 years bodily injury litigation claim handling or comparable claim litigation experience.

LINK TO JOB DESCRIPTION\: https\://ccsd.net/employees/resources/pdf/desc/ap/BFD/A419.pdf Application Persons interested in the position and who meet the minimum qualifications should submit the required online application. This position is open until filled. To receive consideration in this selection process, the following required materials must be submitted electronically where prompted on the on-line application, no later than the closing date specified above: Cover letter that highlights and provides examples of how your work experience relates to the essential duties and position expectations, a current resume, three (3) letters of recommendation, and official transcripts (If applicable). Current and previous employers may be contacted for references, and applicants for this position are subject to a thorough background investigation. Please direct all questions to the Administrative Services Department at *************. Please ensure that you complete the entire seven (7) year work history in the “Experience and Credentials” section of your application, including periods of unemployment, schooling and volunteer work.

Workers' Compensation Claim Specialist Schedule: Monday-Friday, 8:00 AM-4:30 PM PT (flexible) Salary Range: $60,000-$80,000 annually Build Your Career With Purpose at CCMSI At CCMSI, we don't just process claims-we support people. As a leading Third Party Administrator and a certified Great Place to Work , we offer manageable caseloads, employee ownership, and a collaborative culture. Our employee-owners are empowered to grow, contribute, and make a meaningful impact. At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile. Reasons you should consider a career with CCMSI: Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm. Career development: CCMSI offers robust internships and internal training programs for advancement within our organization. Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP. Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads. The Workers' Compensation Claim Specialist is responsible for the investigation and adjustment of assigned claims. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The Claim Representative is accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards. Responsibilities Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws. Establish reserves and/or provide reserve recommendations within established reserve authority levels. Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution. Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority. Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate. Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.) Review and maintain personal diary on claim system. Assess and monitor subrogation claims for resolution. Compute disability rates in accordance with state laws. Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process. Provide notices of qualifying claims to excess/reinsurance carriers. Compliance with Corporate Claim Handling Standards and special client handling instructions as established. Performs other duties as assigned. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills. Initiative to set and achieve performance goals. Good analytic and negotiation skills. Ability to cope with job pressures in a constantly changing environment. Knowledge of all lower level claim position responsibilities. Must be detail oriented and a self-starter with strong organizational abilities. Ability to coordinate and prioritize required. Flexibility, accuracy, initiative and the ability to work with minimum supervision. Discretion and confidentiality required. Reliable, predictable attendance within client service hours for the performance of this position. Responsive to internal and external client needs. Ability to clearly communicate verbally and/or in writing both internally and externally. Education and/or Experience Ten years claims experience is required. Bachelor degree is preferred. Computer Skills Proficient using Microsof Office products such as Word, Excel, Outlook, etc. Certificates, Licenses, Registrations Adjuster's license may be required based upon jurisdiction. AIC, ARM OR CPCU Designation preferred. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work requires the ability to stoop, bend, reach and grab with arms and hands, manual dexterity. Work requires the ability to sit or stand up to 7.5 or more hours at a time. Work requires sufficient auditory and visual acuity to interact with others. CORE VALUES & PRINCIPLES Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example. Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team. Equal Opportunity Employer: CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment. #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #ClaimsJobs #RemoteWork #WorkersCompCareers #InsuranceJobs #NowHiring #IND123 #LI-Hybrid We can recommend jobs specifically for you! Click here to get started.

Join an amazing team that is consistently recognized for our achievements and culture, including our most recent Forbes award of being one of America's Best Midsize Employers for 2025! If you're passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors. The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers. Geo-Salary Information An in-person interview may be required during the hiring process State specific pay scales for this role are as follows: $68,141 to $119,013 (NV, OR, AZ, CO, WY, TX, ND, MN, MO, IL, WI, FL, GA, MI, OH, VA, PA, DE, VT, NH, ME) The expected base salary for this position will vary depending on a number of factors, including relevant experience, skills and location. Responsibilities Essential Job Functions: • Investigate and resolve Homeowners claims of moderate complexity in a timely and efficient manner. Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes. • Ability to perform field inspections at least 50% of work time. (company car provided) This will involve travelling to our customers' home to conduct on-site inspections, thoroughly investigate coverage and prepare detailed estimate to efficiently resolve their claims. • Ability to handle virtual claims. Must have ability to use imagery, and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting when needed. • Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate. • Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval. • Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction. This includes timely response to phone calls, emails, texts, written communication, and adherence to Department of Insurance requirements. • Prioritizes own responsibilities and effectively manages claims workload to regularly monitor progress and expenses to properly resolve inventory to conclusion. • At times may direct, monitor, and review files handled by independent adjusters to conclusion. • Other functions may be assigned Qualifications Education: • Bachelor's degree preferred or equivalent combination of education and experience. • Valid driver's license is required. • Ability to obtain state specific property claims licensing, as required. • Must successfully participate and complete formal property claims training program that may take place in person, virtually, or a combination of both. Experience: • Have prior experience using estimating software like Xactimate. • Experience in a related field: property claims experience, customer service environment, construction, restoration, mitigation • Are known for clear and professional communication, both written and verbal • Are bilingual and/or have prior military experience is a plus • 3-5+ years equivalent industry experience is preferred Knowledge and Skills: As a Property Claims Field Adjuster 2, you will: • Possess the ability to work independently with limited or no supervision over daily activities required to successfully investigate, evaluate, write damage estimates, negotiate, and resolve property claims • Have a passion for outstanding customer service • Make quality decisions based upon a mixture of analysis, wisdom, experience, and judgment, including the ability to negotiate. • Be comfortable with and adaptable to new technology and business tools • Be able to seamlessly transition between various methods of inspection, including physical, video, or photo, to write a damage estimate: o May include climbing ladders to inspect roofing or attic space and inspection of crawl spaces. o Ability to lift and carry up to 50 pounds. • Possess strong organizational, time management, and prioritization skills to handle varying workloads due to seasonal volume changes and catastrophes. • Be able and willing to work flexible work shifts and may be asked to work overtime, as needs arise. • Drive to and from multiple locations and occasionally outside of normal business hours. About the Company Why choose a career at Mercury? At Mercury, we have been guided by our purpose to help people reduce risk and overcome unexpected events for more than 60 years. We are one team with a common goal to help others. Everyone needs insurance and we can't imagine a world without it. Our team will encourage you to grow, make time to have fun, and work together to make great things happen. We embrace the strengths and values of each team member. We believe in having diverse perspectives where everyone is included, to serve customers from all walks of life. We care about our people, and we mean it. We reward our talented professionals with a competitive salary, bonus potential, and a variety of benefits to help our team members reach their health, retirement, and professional goals. Learn more about us here: ********************************************** Perks and Benefits We offer many great benefits, including: Competitive compensation Flexibility to work from anywhere in the United States for most positions Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours) Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus) Medical, dental, vision, life, and pet insurance 401 (k) retirement savings plan with company match Engaging work environment Promotional opportunities Education assistance Professional and personal development opportunities Company recognition program Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more Mercury Insurance is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by federal, state, or local law. Pay Range USD $74,955.00 - USD $130,915.00 /Yr.

**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** 2 **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. **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 preferred. + 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 preferred. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. + Valid driver's license - required. **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 ******************************************************** .

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR KlGXTRKkWK

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - General Liability | Hawaii License Required Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS Hybrid 2 Days In-Office PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. * Assesses liability and resolves claims within evaluation. * Negotiates settlement of claims within designated authority. * Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. * Prepares necessary state fillings within statutory limits. * Manages the litigation process; ensures timely and cost effective claims resolution. * Coordinates vendor referrals for additional investigation and/or litigation management. * Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. * Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. * Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. * Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. * Ensures claim files are properly documented and claims coding is correct. * Refers cases as appropriate to supervisor and management. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge * Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Good interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Service Expectations TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $90,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.