To be considered, please apply through the link here.
We are seeking an experienced and independent Insurance Claims Specialist with 7+ years of multi-line claims experience to manage and resolve claims across Marine Cargo, Property & Casualty, Automobile, Workers' Compensation, and Liability/Litigation.
The role also supports contract reviews by assessing insurance-related provisions to ensure alignment with policy coverage and claims protocols. The ideal candidate will also provide support to the Insurance Manager and General Manager on special insurance projects as needed, contributing to broader departmental goals and demonstrating flexibility beyond core claims duties.
ESSENTIAL JOB DUTIES:
Manage the end-to-end claims process for:
-Marine cargo/inland transit
-Commercial property and general liability
-Automobile (fleet and HNOA)
-Workers' Compensation (“WC”)
-Litigated liability claims, including bodily injury and third-party property damage
Handle end-to-end claims for marine, property, liability, auto (fleet/HNOA), WC, and litigated matters including bodily injury and third-party property damage.
Review policies to assess coverage, exclusions, deductibles, and retentions
Coordinate with brokers, carriers, adjusters, and Internal legal counsel
Support contract review by evaluating insurance clauses (limits, AI, Waiver of Subrogation) and identifying potential risk/coverage gaps
Draft claim notifications and ensure compliance with policy timelines
Provide loss history, reserve, and claim summaries to assist with renewal preparation
Collaborate with Legal, MGC, and MAC BU Operations to resolve claims
Participate in claim reviews and strategic discussions in recovery efforts
Support the GM and Insurance Manager with special insurance-related projects as needed, and demonstrate flexibility in cross-functional assignments.
MINIMUM EDUCATION REQUIREMENTS:
Bachelor's degree in insurance or business-related fields or equivalent experience.
MINIMUM EXPERIENCE AND CAPABILITY REQUIREMENTS:
7+ years of insurance claims experience across multiple P&C lines, including marine and litigated claims.
Strong working knowledge of insurance policy language, ISO forms, and manuscript policies.
Familiarity with contractual risk transfer principles and ability to analyze insurance-related clauses.
Experience coordinating with external counsel and adjusters on complex/litigated claims.
Proficiency in claims systems, Microsoft Word and Excel, and document management platforms.
Technically skilled in both claims handling and policy interpretation.
Detail-oriented with excellent judgment and risk awareness.
Confident in reviewing contract language from an insurance perspective.
Collaborative and able to communicate effectively with both technical and non-technical stakeholders.
Able to manage competing priorities and operate independently.
Must have the ability to work with deadlines and work in a fast-paced and dynamic work environment.
Requires excellent written and verbal communication skills.
Must be able to work in a multi-cultural business environment.
JOB-RELATED CERTIFICATION:
CPCU, ARM, or AIC designation preferred
$46k-71k yearly est. 4d ago
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Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim processor job in New York
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$103.3k-140k yearly 38d ago
Claims Cash Processor
Global Channel Management
Claim processor job in New York
Cash ClaimsProcessor needs 3 years experience
Cash ClaimsProcessor requires:
Working knowledge of mainframe computers and systems in general, ie: AS400.
Understands third party benefits and administration.
Minimum keystrokes per hour requirement of 10,000 with less than 2% error rate. High level of detail orientation.
Flexibility working in both a team and individual environments.
Proficient in Microsoft Excel applications.
Cash ClaimsProcessor duties:
Process transactions
Apply cash
Member bills
Resubmit invoices, write-offs, etc.
Follow data processing guidelines to meet established departmental standards
Communicate with supervisor regarding transactions processed in a timely manner.
Identify and recommend systems and process modifications necessary to improve the efficiency and effectiveness of the Assignment processes
.
$35k-64k yearly est. 60d+ ago
Complex Claims Examiner -FAIRCO
Transatlantic Reinsurance Company 4.8
Claim processor job in New York, NY
For a description, see PDF at: ************ transre. com/wp-content/uploads/2025/10/FAIRCO-Complex-Claims-Examiner.
pdf
$51k-90k yearly est. 56d ago
Cyber Claims Specialist
Sea Wolf Executive Search
Claim processor job in New York
We are seeking a Complex Cyber Claims Specialist to join our team of dedicated professionals in the insurance industry. As a Complex Cyber Claims Specialist, you will be responsible for handling complex cyber claims for our clients. The ideal candidate for this position will have several years of cyber claims handling experience (JD preferred but not required).
Responsibilities:
Investigate and evaluate complex cyber claims to determine coverage and liability.
Analyze legal and technical issues related to cyber claims.
Work with attorneys, experts, and other professionals to resolve complex claims.
Develop and maintain strong relationships with clients, brokers, and underwriters.
Provide guidance and support to other claims professionals.
Ensure compliance with company policies and procedures.
Monitor trends and developments in the cyber insurance industry.
Requirements:
Several years of cyber claims handling experience, (JD is preferred but not required).
Strong analytical and problem-solving skills.
Excellent communication and interpersonal skills.
Ability to work independently and as part of a team.
Familiarity with insurance policies and coverage.
Knowledge of cyber risk and related legal issues.
Strong attention to detail and organizational skills.
Ability to handle multiple tasks and priorities.
Benefits:
We offer a competitive salary dependent upon experience, a bonus anywhere from 10-20%, flexible work schedule, and great benefits including medical, dental, vision, life insurance, and 401(k) retirement plan. The work week is 35 hours.
If you are looking for an exciting opportunity to join a leading international insurance carrier and work with a team of dedicated professionals, we encourage you to apply for this position.
$43k-75k yearly est. 60d+ ago
Commercial Auto Bodily Injury Claims Examiner
King's Insurance Staffing LLC 3.4
Claim processor job in New York, NY
Job DescriptionOur client is actively seeking a seasoned Commercial Auto Bodily Injury Claims Adjuster to join their growing NYC team. This person will be responsible for managing a portfolio of moderate to complex claims involving commercial auto exposures, often including litigated files. From first notice to final resolution, you'll drive the claims process with precision, ensuring timely outcomes and outstanding service. Key Responsibilities:
Conduct thorough investigations and evaluations of commercial auto bodily injury claims, exercising sound judgment within designated authority limits to ensure prompt and fair resolution.
Manage a caseload consisting of 100 - 110 Commercial Auto files with bodily injury exposures.
Collaborate with claimants, legal representatives, and other stakeholders to negotiate settlements, issue payments, and bring claims to closure effectively.
Maintain accurate documentation and prepare detailed claim status reports to support transparency and compliance throughout the claims lifecycle.
Requirements:
5 to 7+ years of experience handling Litigated Commercial Auto Bodily Injury claims.
Strong analytical thinking and attention to detail to assess coverage, liability, and damages accurately.
Excellent negotiation and communication skills, with the ability to manage complex interactions confidently.
Proficiency in modern claims management software and related technologies.
Active adjusters license, highly preferred.
Salary & Benefits:
Competitive base salary ranging from $95,000 to $110,000, depending on experience.
Comprehensive benefits package, including health, dental, and vision insurance.
Generous PTO and paid holidays.
Clear pathways for career advancement.
401(k) plan with competitive employer matching.
$38k-45k yearly est. 16d ago
Epic Medical Analyst
Your It Recruiter
Claim processor job in New York
Your IT Recruiter is looking for an Epic Medical Analyst for our client.
An Epic Medical Analyst, also referred to as an Epic Analyst or Epic Clinical Analyst, is an IT professional in healthcare specializing in the Epic Electronic Health Record (EHR) system. Their primary responsibilities revolve around implementing, optimizing, maintaining, and supporting Epic modules to enhance patient care and streamline workflows within healthcare organizations.
Here's a breakdown of the key responsibilities, qualifications, and skills typically found in an Epic Medical Analyst job description:
Key responsibilities and duties
System configuration and maintenance
Business Analysis and Workflow Improvement:
Analyzing current workflows, identifying areas for improvement, and implementing Epic solutions to enhance efficiency.
Collaborating with clinical and administrative teams to understand their needs and develop solutions within Epic.
User Training and Support:
Providing training to users on how to effectively utilize Epic, offering ongoing support, and addressing user inquiries.
Documentation and Reporting:
Creating and maintaining documentation, training materials, and user guides.
Utilizing Epic's reporting tools to extract and analyze data for decision -making and quality improvement purposes.
Collaboration and Communication:
Working closely with clinical, IT, and administrative teams to ensure system requirements are met and to facilitate smooth implementation and ongoing support.
Testing and Quality Assurance:
Conducting system testing, quality assurance, and ensuring system updates and patches are properly implemented.
Process Improvement: Participating in process improvement projects to enhance efficiency and accuracy.
Requirements
Required qualifications
Education: Typically requires a Bachelor's degree in a related field such as Computer Science, Healthcare Information Technology, or Health Information Management. A Master's degree may be preferred.
Experience: Minimum of one year of experience with the build and/or maintenance of Epic modules is often required. Some positions may prefer two or more years of relevant experience.
Certification: Epic Certification in relevant modules (e.g., EpicCare Ambulatory, EpicCare Inpatient, Clinical Documentation) is usually a requirement or highly preferred, according to Medisys Health Network, Hospital for Special Surgery, and ZipRecruiter.
Necessary skills
Key skills for an Epic Medical Analyst include strong communication, organization, attention to detail, and the ability to multitask and work independently. Technical expertise in healthcare, IT and troubleshooting is essential. Analytical and problem -solving abilities are important, as is the capacity to collaborate with diverse teams. A solid understanding of healthcare operations, clinical workflows, and proficiency in Microsoft Office Suite are often required. Knowledge of HIPAA and other healthcare data privacy regulations is necessary. Staying current with industry trends and advancements in Epic applications is also valued.
Overall, an Epic Medical Analyst is crucial for ensuring the Epic EHR system effectively supports a healthcare organization's operations, leading to improved patient care and efficiency.
BenefitsContract Role
$35k-55k yearly est. 16d ago
Pharmacy Claims Adjudication Specialist
Onco360 3.9
Claim processor job in New York
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $28.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 28, 2026. We offer a variety of benefits including:
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Document and submit requests for Patient Refunds when appropriate.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law
Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
$28 hourly 17d ago
Claims Examiner I - SSL
Standard Security Life Insurance Company of New York
Claim processor job in Canandaigua, NY
Job Responsibilities and Requirements
KEY RESPONSIBILITIES
*other duties as assigned*
The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations.
Research
Develop an understanding and working knowledge of disability and paid family leave
Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements.
Develop an operating knowledge of the applicable claims system(s).
Develop basic claims skills and an understanding of claim practices and procedures.
Utilizes most efficient means to obtain claim information.
Analysis and Adjudication
Fully investigates all relevant claim issues with oversight by Manager when needed.
Provides payment or denials promptly and in full compliance with department procedures and regulations.
Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim.
Pro-actively communicates with claimants, policyholders, and physicians when applicable
Case Management
Utilizes appropriate intervention for the characteristics of each claim.
Manages assigned case load and processes within the specified time requirements.
Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system.
Customer Service
Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
Establishes, communicates, and manages claimant and policyholder expectations.
Documents claim file actions and telephone conversations appropriately.
Ability to handle confidential information with the utmost judgment and discretion
REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE
*or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*
Required Knowledge, Skills, Abilities and/or Related Experience
High school diploma (or equivalent)
Must have 1-3 years of New York State statutory Disability and Paid Family leave claims processing experience to be considered for this role.
Experience with Microsoft Office
Work experience in decision-making and information analysis.
Demonstrated prioritization and organization skills.
Ability to communicate clearly and succinctly verbally and in writing
Must be able to work in a team oriented environment.
Meet and exceed production, attendance, quality and service
Ability to organize work, manage time and follow through
Availability to work overtime when required
Ability to Travel: None
PHYSICAL REQUIREMENTS
When used in the description below, the following terms are defined as:
“Occasional”: done only from time to time, but necessary when it is performed
“Frequent”: regularly performed; generally an act that is required on a daily basis
“Continuous”: typically performed for the majority of an employee's shift
Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.
CORE VALUES
Collaboration
Compassion
Empowerment
Integrity
Fun
The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job.
The expected hiring range for this position is $22.41 - $28.02 hourly for work performed in the primary location (Canandaigua, NY). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future.
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you.
That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.
Our Benefits:
An annual performance bonus for all team members
Generous 401(k) company match that is immediately vested
A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
Multiple options for dental and vision coverage
Company provided Life & Disability Insurance to ensure financial protection when you need it most
Family friendly benefits including Paid Parental Leave & Adoption Assistance
Hybrid work arrangements for eligible roles
Tuition Reimbursement and Continuing Professional Education
Paid Time Off - new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service.
Volunteer days, community partnerships, and Employee Assistance Program
Ability to connect with colleagues around the country through our Employee Resource Group program
Our Values:
Integrity
Empowerment
Compassion
Collaboration
Fun
EEO Statement
Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.
#LI-Remote #LI-AS1
$22.4-28 hourly Auto-Apply 60d+ ago
Billing/Claims Specialist
P4P
Claim processor job in New York, NY
Job DescriptionLocation: Brooklyn, NY Salary: $52K-$80KThe Billing and Claims Specialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials.Key Responsibilities for Billing/Claims Specialist:
Billing & Claims Processing
Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance
Review authorizations, service hours, and eligibility prior to billing
Ensure accurate coding and claim data in accordance with payer guidelines
Process electronic and paper claims as required by payers
Claims Follow-Up & Reconciliation
Monitor claim status and follow up on unpaid, denied, or underpaid claims
Investigate and resolve billing discrepancies and denials
Submit corrected or resubmitted claims as needed
Post payments, adjustments, and denials accurately into billing systems
Reconcile remittance advice (EOBs/ERAs) with billed claims
Authorization & Compliance
Track MLTC authorizations, service limits, and expiration dates
Ensure billing aligns with approved care plans and service authorizations
Maintain compliance with Medicaid, MLTC, and insurance regulations
Stay current on payer rule changes and billing requirements
Qualifications for Billing/Claims Specialist:
Required
Minimum 2-3 years of billing and claims experience in home care, healthcare, or related setting
Hands-on experience with MLTC billing and insurance claims
Strong knowledge of Medicaid and managed care billing processes
Proficiency with home care billing software and clearinghouses
Excellent attention to detail and organizational skills
$52k-80k yearly 17d ago
Complex Claims Specialist-MPL
Hiscox
Claim processor job in Boston, NY
Job Type:
Permanent
Build a brilliant future with Hiscox
Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required.
Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization.
Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations:
Manhattan, NY
West Hartford, CT
Atlanta, GA
Chicago, IL
Boston, MA
The Role:
The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also:
Adjusts and resolves complex to severe claims that includes all phases of litigation
With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
Reviews and analyses claim documentation and legal filings
Drives litigation best practices to lead defense strategy on litigated files
Mentors Claim Examiners
Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
Identifies emerging exposures and claims trends
Identifies suspected fraudulent claims and tracks with special investigations unit
Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
Develops content and conducts training for claims team and underwriters as requested
The Team:
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling.
Requirements:
8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.)
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Advanced knowledge of coverage within the team's specialty or focus
Advanced knowledge of litigation process and negotiation skills
Experience in mentoring and training other claims examiners
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University preferred
Additional Factors Considered:
Ability to act a subject matter expert within team
Demonstrated ability to work with minimal oversight
Experience attending and leading mediations, arbitrations and trials
Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects
Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers
Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation
Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars.
What Hiscox USA offers:
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short- term disability and long-term disability coverage
24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
Paid parental leave
4-week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox USA:
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
Diversity and flexible working at Hiscox:
At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range: $125,000-$155,000
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-RM1
Work with amazing people and be part of a unique culture
$40k-70k yearly est. Auto-Apply 20d ago
Insurance Claims Specialist
Ultimate Care Assisted Living Management
Claim processor job in Ronkonkoma, NY
Job Description
The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.
DUTIES AND KEY RESPONSIBILITIES:
Claims Management and Oversight
Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
Respond to inquiries and concerns regarding new and existing claims
Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
Compliance and Reporting
Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
Monitor claim trends and identify risk mitigation opportunities.
Financial Coordination and Invoicing
Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
Work with finance team to place and monitor appropriate reserves and allocate funds.
Data Analytics and Reporting
Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
Collaboration and Communication
Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
Provide regular updates to management on claims status, strategic initiatives, and risk trends.
Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.
QUALIFICATIONS:
3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
Associate's degree required.
Excellent customer service skills
Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
Exceptional interpersonal, verbal, and written communication skills
Proven customer relationship and conflict resolution skills
Ability to develop and maintain strong working relationships with internal and external parties
Strong attention to detail and accuracy in data entry and record keeping
Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.
$43k-76k yearly est. 31d ago
Transactional Risk Claims Specialist
Hyperiongrp
Claim processor job in New York, NY
Who are we?
Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
Classification: Exempt/Full-time
Reports to: Head of Claims for Transactional Risk
Travel: 0-15%
Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team.
The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
Assist with entering claim data into operational systems.
Assist with quality control and performance management, to ensure high-quality claim handling.
Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
Perform other duties as assigned.
Key requirements
Bachelor's degree required and law degree preferred.
Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
Ability to manage multiple competing priorities.
Ability to adapt to evolving regulatory and legal environments.
Complete assigned tasks correctly, on time and able to learn quickly.
Self-motivated and demonstrating attention to detail.
Be able to work independently for extended periods.
Excellent written and verbal communication skills as well as general business understanding.
Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
Our successes have all come from someone brave enough to try something new
We support each other in the small everyday moments and the bigger challenges
We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
*Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
$43k-77k yearly est. Auto-Apply 51d ago
Claims Specialist
Sourcepro Search
Claim processor job in New York, NY
SourceProSearch is seeking a Claims Specialist with 1-2 years of experience to work in our New York office. The ideal candidate should be comfortable with technology and platforms. This position requires at least 2 days per week in the office.
Job Responsibilities:
Format documents and communications for clients.
Liaise between third-party vendors and the firm.
Review documents (release/document verification) for production to defense counsel for quality control.
Calendaring and entry of case info into the database.
Perform intake and initial filtering of client inquiries.
Preparation of submissions involving large volumes of individual claims.
Run and analyze client data reports.
Organize documents and communications with clients.
Ensure that case documents accurately reflect a client's individual information.
Keep track of communications or developments relating to client cases and deadlines that may be applicable to individual clients.
Prepare and send client communications.
Communicate with clients telephonically, on occasion.
Work with attorneys to plan data gathering and settlement update workflows.
Analyze and summarize client inquiries to identify trends and patterns requiring further action.
Assist with the development of processes and technological systems for addressing large volumes of client interactions.
Skills/Requirements:
Proficient in the use of Microsoft Word and Excel.
Familiarity with Filesite preferred.
Familiarity with client management systems or databases preferred.
Strong technical skills and ability to quickly learn new litigation support software.
Strong written and oral communication skills and strong interpersonal skills.
Must possess great attention to detail.
Must possess analytical and critical thinking skills.
Strong organizational and time-management skills.
Ability to work independently while understanding the importance of teamwork.
Ability to manage workload consisting of multiple tasks.
The work shift for this position is 9:30 am-5:30 pm, five days a week, but the applicant must be willing and available to work overtime, both evening and weekends, when necessary.
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$43k-77k yearly est. 60d+ ago
Claims Specialist
P & A Administrative Services
Claim processor job in Williamsville, NY
Full-time Description
We're looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you'll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise.
Key Responsibilities
Accurately process claims within established timelines
Review and complete claim adjustment requests
Research claim reversal requests to determine approval or denial
Manage debit card dispute workflows, including fraudulent or disputed transactions
Provide clear and professional responses to routine phone and written inquiries related to claim processing
Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules
Adjudicate transactions that fail auto-review and determine whether additional documentation is needed
Requirements
High School Diploma or equivalent
Knowledge of ERISA guidelines preferred
Strong written and verbal communication skills with excellent attention to detail
Ability to manage multiple priorities using strong organizational and time-management skills
Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally
Self-starter who can work independently in a fast-paced environment with critical deadlines
An Equal Opportunity Employer.
Salary Description 16.00 - 18.00
$40k-69k yearly est. 58d ago
Complex Claims Examiner
Nyt Usd
Claim processor job in Day, NY
About Us
Since 1977 we have delivered first class solutions to insurers worldwide, by combining global reach with local decision making. We have built customer & broker relationships on years of trust, experience and execution. Through our people, our products and our partnerships, we deliver the capacity and expertise necessary to contribute to the sustainable growth of prosperous communities worldwide. To do so, our colleagues work with:
Integrity Work honestly, to enhance TransRe's reputation
Respect Value all colleagues. Collaborate actively.
Performance We reward excellence. Be accountable, manage risk and deliver TransRe's strengths
Entrepreneurship Seize opportunities. Innovate for and with customers.
Customer Focus Anticipate their priorities. Exceed their expectations.
We have the following job opportunity in our New York City office:
Description
We seek an experienced claims professional to join our growing FAIRCO team in our New York City office. FAIRCO is a subsidiary of TransRe Holdings, a Berkshire Hathaway company. As a member of FAIRCO, the Complex Claims Examiner will be responsible for adjusting Professional & Management Liability claims, with opportunities for experiences with other FAIRCO programs. Responsibilities will include but not be limited to:
Managing and adjusting primary and excess Professional & Management Liability claims, including private and public company, Directors and Officers, lawyers liability, accountants liability, financial institutions, cyber, employment practices and miscellaneous professional liability.
Proactively handling claims throughout the entire claim lifecycle from inception to resolution.
Analyzing policy coverage and drafting coverage analyses based on contract terms and claim details.
Evaluating liability and damages to determine the level of exposure to the insured and the policy.
Directing and closely monitoring assignments to defense counsel and experts in accordance with relevant guidelines.
Collaborating with underwriters, brokers, program partners, and insureds to ensure seamless claims resolution.
Traveling to and attending claims mediations, as required.
Developing and implementing claims handling strategies to mitigate risk and reduce claim expenses.
Requirements
The ideal candidate will possess the following knowledge, skills and abilities:
Extensive experience litigating or handling issues pertaining to complex Professional & Management Liability issues, with a focus on Directors and Officers coverage.
Experience leading mediations for Professional & Management Liability claims.
Experience evaluating coverage under various types of policies, drafting coverage correspondence, and participating in claims investigations.
Track record of effectively managing defense counsel and legal spend, assessing liability and financial exposure, and effectively negotiating cost effective, good faith claims resolutions.
Juris Doctorate preferred.
Willingness to travel up to 25% of the time for mediations, industry conferences, and client meetings.
Possession of, or willingness to obtain, a New York and other state adjuster's licenses.
Work Schedule
TransRe is supportive of an agile work schedule, which may differ based on individual roles, your local office's practices and preferences, marketplace trends, and TransRe's business objectives. This position is eligible for a hybrid work schedule with 3 days in the office per week, and 2 days remote.
Compensation
In addition to base salary, for this position, TransRe offers a comprehensive benefits package, paid time off, and incentive pay opportunity. The anticipated annual base salary range in New York for this position, exclusive of benefits, paid time off, and incentive pay opportunity is $140,000 - $180,000. This range is an estimate, and the actual base salary offered for this position will be determined based on certain factors, including the applicant's specific skill set and level of experience.
We are an Equal Opportunity Employer (EOE) and we support diversity in the workforce.
$30k-56k yearly est. Auto-Apply 60d+ ago
Part-Time Commercial Lines Claims Specialist
Bridge Specialty Group
Claim processor job in Somers, NY
Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.
Brown & Brown is Seeking a Commercial Lines Claims Specialist to join our growing team in Somers, NY.
Part-Time Claims position. Accept and oversee all types of Commercial Auto Claims for accounts assigned. Assist in servicing consulting contracts. Provide prompt, accurate and courteous claim service to the Agency's customers, both internal and external.
How You Will Contribute
Acceptance of claims, making assignments to companies and/or independent services.
Research coverage, leases and contracts and participate in discussions with Account Mangers and producers regarding same.
Reading, analyzing, and processing of litigation paperwork.
Reserve monitoring and communication with Companies regarding evaluation of same.
Ongoing assistance in claims management of company claims.
Maintain diary system relating to first party losses, claims in subrogation, and Select Top 100 losses.
Completion of reports and suit activities as department policy dictates.
Assist underwriting staff with claim information relating to policies qualifying for experience rating and/or workers' compensation dividend plans.
Complete monthly report to clients which includes loss run and tracking of the physical damage claims.
Complete monthly billing to clients for services.
Preparation of claims management reports and experience modification reports as required by account size.
Skills & Experience to Be Successful
Minimum of two years college required.
Two to four years claims adjusting experience, preferably commercial lines involving both first- and third-party claims.
Arbitration forums participation
Valid Driver's license.
This position requires routine or periodic travel which may require the teammate to drive their own vehicle or a rental vehicle. Acceptable results of a Motor Vehicle Record report at the time of hire and periodically thereafter, and maintenance of minimum acceptable insurance coverages are a requirement of this position.
College degree.(preferred)
#LI-DA1
Pay Range
$30.00 - $39.00 Hourly
The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.
Teammate Benefits & Total Well-Being
We go beyond standard benefits, focusing on the total well-being of our teammates, including:
Health Benefits
: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
Financial Benefits
: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
Mental Health & Wellness
: Free Mental Health & Enhanced Advocacy Services
Beyond Benefits
: Paid Time Off, Holidays, Preferred Partner Discounts and more.
Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.
The Power To Be Yourself
As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.
$30-39 hourly Auto-Apply 54d ago
Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim processor job in New Hartford, NY
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$103.3k-140k yearly 38d ago
Billing/Claims Specialist
P4P
Claim processor job in New York, NY
Location: Brooklyn, NY Salary: $52K-$80K The Billing and Claims Specialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials. Key Responsibilities for Billing/Claims Specialist:
Billing & Claims Processing
Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance
Review authorizations, service hours, and eligibility prior to billing
Ensure accurate coding and claim data in accordance with payer guidelines
Process electronic and paper claims as required by payers
Claims Follow-Up & Reconciliation
Monitor claim status and follow up on unpaid, denied, or underpaid claims
Investigate and resolve billing discrepancies and denials
Submit corrected or resubmitted claims as needed
Post payments, adjustments, and denials accurately into billing systems
Reconcile remittance advice (EOBs/ERAs) with billed claims
Authorization & Compliance
Track MLTC authorizations, service limits, and expiration dates
Ensure billing aligns with approved care plans and service authorizations
Maintain compliance with Medicaid, MLTC, and insurance regulations
Stay current on payer rule changes and billing requirements
Qualifications for Billing/Claims Specialist:
Required
Minimum 2-3 years of billing and claims experience in home care, healthcare, or related setting
Hands-on experience with MLTC billing and insurance claims
Strong knowledge of Medicaid and managed care billing processes
Proficiency with home care billing software and clearinghouses
Excellent attention to detail and organizational skills
$52k-80k yearly 15d ago
Pharmacy Claims Adjudication Specialist
Onco360 3.9
Claim processor job in Buffalo, NY
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $23.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 28, 2026. We offer a variety of benefits including:
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Document and submit requests for Patient Refunds when appropriate.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law
Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills