Claim processor jobs in Pittsburg, CA - 71 jobs

A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits. #J-18808-Ljbffr

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor's degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM. Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims. Duties and Responsibilities Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards. Prepare accurate and timely issuance of benefits notices and required reports within statutory limits. Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits. Ensure timely payment of benefits, bills and appropriate caseload and performance goals. Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data. Monitor, report, and assign claims for fraud potential and subrogation possibilities. Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws. Prepare and present claims summaries to clients during file reviews. Train and direct Claims Assistants to meet goals and deadlines. Review and approve priority payments and other documents from Claims Assistants. Performs other duties as assigned Knowledge, Skills, and Abilities Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions. Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits. Strong skills with use of general office administration technology, including Microsoft Office Suite and related software Excellent verbal and written communication skills Excellent interpersonal and conflict resolution skills Excellent organizational skills and attention to detail Excellent interpersonal, negotiation, and conflict resolution skills Strong analytical and problem-solving skills Ability to act with integrity, professionalism, and confidentiality, at all times The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. JT2 Integrated Resources 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.

About the Company For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss. About the Role The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports. This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role. Key Responsibilities Case Management & Communication Receive, review, and manage assigned cases from start to completion. Communicate professionally with clients, claimants, witnesses, and other involved parties. Provide timely case updates and correspondence in accordance with company guidelines via CaseLink. Maintain objectivity and professionalism in all interactions. Investigative Field Work Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings. Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires. Perform scene and neighborhood canvasses, including walking on varied terrain. Meet with treating physicians and medical offices as required. Travel to designated locations, including overnight stays when necessary. Respond to rush cases within business hours when required. Documentation & Reporting Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis. Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired. Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements. Prepare and submit comprehensive investigative reports within 72 hours of final update submission. Evidence & Records Handling Retrieve records from agencies and entities both in-person and remotely. Take clear photographs and video when necessary and label all electronic files accurately. Securely collect, store, and maintain custody of evidence when required. Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure. Additional Responsibilities Identify and recommend additional investigative services outside the scope of the original assignment when appropriate. Work overtime as needed to meet case demands and deadlines. Maintain an efficient, safe, and organized telecommuter workspace. Physical & Work Environment Requirements Ability to sit for extended periods performing computer-based work and report writing. Ability to stand for extended periods while conducting interviews and canvasses. Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment). Ability to operate digital audio recording equipment. Qualifications Experience with workers' compensation claims and investigative processes. Strong written and verbal communication skills. Ability to work independently, manage time effectively, and meet strict deadlines. Willingness and ability to travel up to (but not limited to) 150 miles per assignment. Possession of a personal credit card with available balance for reimbursable business expenses. Proficiency with case management systems; CaseLink experience preferred. Access to a personal scanner for document upload and record handling. Preferred Qualifications Prior experience conducting recorded statements and field investigations. Experience with process service assignments. Familiarity with evidence handling and documentation standards. Background in insurance investigations or a related field.

DETAILS Assistant Claims Examiner - Flex Department: Workers' Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 6 Career Ladder: Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers' Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. Answer questions over the phone from medical providers regarding bills Contact treating physician for disability status Contact employer for return-to-work status or availability of modified work. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators Complete preparation of documents for overnight delivery Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners Contact with clients, injured workers, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required 2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferred Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses Administrators Certificate from Self-Insurance Plans preferred Knowledge of workers compensation laws, policies, and procedures Understanding of medical and legal terminology Must demonstrate accuracy and thoroughness in work product Ability to sit for prolonged periods of time Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

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 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 an experienced Workers' Compensation Claim Supervisor with deep California jurisdiction expertise to lead a team of 3-6 adjusters supporting a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch. This is a hands-on leadership role for a supervisor who understands the full California workers' compensation lifecycle-from intake through resolution-and can coach adjusters through complex, fast-paced claims while ensuring strict compliance with regulatory and client-specific requirements. You'll guide claim strategy, mentor your team, and partner closely with clients to deliver consistent, high-quality outcomes. Responsibilities When we hire claim supervisors at CCMSI, we look for leaders who believe strong teams create strong outcomes-leaders who own results, develop people, and treat every claim with purpose and care. Supervise and guide a team of 3-6 California Workers' Compensation adjusters handling cradle-to-grave claims Ensure claims are investigated, evaluated, and resolved accurately, timely, and in compliance with California WC laws Review claim files regularly, providing direction on complex, litigated, or high-exposure matters Oversee reserve accuracy and compliance with client handling instructions Participate in claim reviews, audits, and quality initiatives Partner with internal teams, clients, and vendors to resolve issues and maintain service standards Recruit, onboard, train, and mentor staff; conduct performance evaluations and manage development plans Address personnel and administrative matters with professionalism and consistency Ensure compliance with carrier/state reporting requirements Qualifications What You'll Bring Required: • 10+ years of WC claims experience (California jurisdiction) • Proven experience adjusting CA WC claims from intake through resolution • CA SIP designation or CA Claims Certificate (or ability to obtain within 60 days) • Demonstrated leadership, coaching, and communication 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. • Experience supporting PEO and/or staffing accounts • 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.

About Stand Stand is a new technology and insurance company revolutionizing how society assesses, mitigates, and adapts to climate risks. Our leadership team has extensive experience in insurance, technology, and climate science: building billions in market value at prior ventures. At Stand, we are rethinking how insurance enables proactive, science-driven resilience. Existing insurance models often rely on broad exclusions, leaving homeowners without options. At Stand, we leverage advanced deterministic models and cutting-edge analytics to provide personalized risk assessments-helping homeowners secure coverage and take proactive steps toward resilience. Why Join Stand: At Stand, you'll join a mission-driven team redefining insurance through the lens of climate resilience, building a transformative, data-driven insurance model with real-world impact for homeowners and communities on the front lines of climate change Location: This role is onsite at either or Tampa, FL office or our San Francisco, HQ. Both are options. Role Summary: As Head of Claims at Stand Insurance, you will be responsible for managing the Claims lifecycle, end-to-end in conjunction with third party partners and the Operations team. Unlike many Claims roles, however, this role is unique in that it also provides an opportunity to be part of the solution in avoiding claims before they happen by working with mitigation and retrofitting vendors. By being involved in the building process before, during, and after a claim, you will be able to ensure we are fulfilling our promise of security to insureds in every facet. This role is great for a high energy, execution focused individual with experience in the most challenging property catastrophe markets. Core Responsibilities: Implement catastrophe response program and strategy for various catastrophe perils in conjunction with TPA partners Build core networks for programs such as water remediation, salvage and subrogation, legal defense, and other approved/recommended contractors that can provide high quality repairs for insureds while managing claim expense Maintain Claims compliance in all states and in all functional areas, such as claims handling practices, reporting, OFAC and CMS Medicare compliance, etc. Develop internal and external staffing, partnerships, and scaling Claims department for expansion of states and products Collaborate with cross-functional teams, including underwriting, product, and actuarial, to collaborate on policy language, underwriting guidelines, and claim reserving practices Help develop best in class wind mitigation vendor networks to help support insureds securing appropriate retrofitting quickly and affordably Work with Product and Technology teams to enhance technology for streamlined claim handling processes and create a seamless and transparent claim experience for insureds Must-Haves 15+ years of property claims experience, predominantly in the personal lines space High-value Homeowners experience Experience in the Florida marketplace is strongly preferred, but generally shall have experience in one or more CATs in a leadership role Comfort working cross-functionally in a fast-paced, entrepreneurial environment Nice-to-Haves Wildfire catastrophe experience Technical competencies and background in designing/working with teams to develop Claims Management software Compensation: The annual base salary range for full-time employees in this position is $150,000 to $210,000+ meaningful Equity Grant. Compensation decisions are dependent on several factors including, but not limited to, an individual's qualifications, location where the role is to be performed, internal equity, and alignment with market data. Additional Benefits: Comprehensive benefits including above-market Health, Dental, Vision Weekly lunch stipend Flexible time off 1-day a week WFH flexibility 401k plan Equal Opportunity Employment Stand is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status. We believe that diversity enriches the workplace, and we are committed to growing our team with the most talented and passionate people from every community. We are committed to providing reasonable accommodations for qualified individuals. If you require assistance Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Title: Customer Service Claims Processor Department: Customer Service Union: OPEIU 29 Grade: 17 The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Major Claims Examiner is responsible for managing complex, high-value workers' compensation claims and ensuring timely, fair resolution in compliance with policy provisions while reducing financial exposure and supporting injured workers' recovery. This position manages assigned major loss claims independently while adhering to company standards and state regulations. ESSENTIAL DUTIES AND RESPONSIBILITIES Investigates and gathers necessary information to resolve assigned claims. Examines major and catastrophic claims to determine coverage, liability, and damages. Communicates with insureds to obtain information necessary for processing claims. Partners with legal counsel on litigation strategies while maintaining file ownership. Attends depositions and conferences exercising appropriate prioritization based on workload. Contacts and/or interview claimants, doctors, medical specialists, or employers to obtain relevant information. Conducts thorough investigations, including reviewing medical records, legal documents, and other supporting evidence. Directs additional investigation of questionable claims to determine compensability. Identifies potential fraud indicators and escalate as necessary. Applies technical knowledge and human relations skills to ensure fair and prompt management of cases. Manages and approves benefit payments within authority limits, ensuring compliance with state regulations and internal standards. Effectively communicates exposure and strategies to senior leadership. Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law and in accordance with company standards. Utilizes structured settlements to resolve high exposure claims. Serves as a mentor and works closely with branch staff to devise strategy for reserving and settlement on high exposure claims, as requested. Identifies opportunities to engage with other company departments including managed care, legal, payment recovery, and SIU. Attends settlement mediations and conferences, as necessary. Participates in claim reviews and service calls with insureds and prospective insureds. Reduces and mitigates Company's financial exposure. Researches historical billing data for facilities and providers to establish accurate file reserves. Analyzes and reports catastrophic and major claims loss data to WCC leaders. Implements proactive and strategic plans to bring claims to a timely and appropriate resolution. Anticipates future developments and exposures and maintain accurate reserves. Pursues subrogation in most cases; refers and/or follows up on subrogation efforts. SUPERVISORY RESPONSIBILITIES This role does not have supervisory responsibilities. EDUCATION AND EXPERIENCE Bachelor's degree in Business Administration, Management, Economics, Accounting, or related field (or equivalent combination of work experience and education). Minimum 10+ years' workers' compensation claims experience with specific experience managing and resolving major claims losses. CERTIFICATES, LICENSES, REGISTRATIONS Required to receive certification that meets the minimum standards of training, experience and skill. Maintain state Workers' Compensation License, as required. Continuing education designations (CPCU, AIC, etc.) or other industry licensing and training programs are preferred. KNOWLEDGE AND SKILLS Expert knowledge of complex claims principles and practices. Proficiency in claims handling systems, analytics tools, and databases. Strong understanding of multi-jurisdictional laws. Ability to apply technical knowledge and human relations skills to ensure fair and prompt management of cases. Skilled in negotiation, strategic decision-making, and mentoring. Advanced critical thinking skills and attention to detail. Excellent verbal and written communication skills, time management, and organizational skills required. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $90,559.93 - $152,723.07 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? Challenging work and the ability to make a difference You will have a voice and feel a sense of belonging We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match Bonus potential for all positions Paid Time Off Paid holidays throughout the calendar year Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities Benefit interpretation and analysis of EOCs across multiple health plans Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories Analysis of authorization rules and Division of Financial Responsibility (DOFR) Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) Assist with maintenance of benefit requirements and configuration decisions and policies and procedures Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance Other duties as assigned Requirements 5+ years of experience in benefits and claims in Managed Care, delegated model setting Experience with benefit analysis and/or quality assurance College degree in healthcare (preferred) or equivalent experience/knowledge Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. Experience with Epic Tapestry (preferred) Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities Knowledge of how benefit configuration relates to claims adjudication and payment processes. Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. Experience with testing, reviewing, and validating benefit plans Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer

Salary Range: $50.42 - $68.08 The Contracts and Legal Claims Specialist oversees contracts management the organization's system. and contract lifecycle, from drafting and preparation to execution; ensuring contractual accountability and duties are met by all parties involved. The role ensures effective administration of the full contract lifecycle, from drafting and review. to execution and compliance monitoring. The Contracts and Legal Claims Specialist is also responsible for coordinating claims and legal matter in collaboration with Vice President, outside legal counsel, insurance carriers and internal stakeholders. The Contracts and Legal Claims Specialist is also responsible for the following duties: Oversite and daily management Management System of the health system's Contract administrative function. Oversite and management of health system policies and numbered memorandums lifecycle with the collaboration stakeholders. on internal Subpoena intake and management for the healthcare system, ensuring timely and accurate response to subpoenas and related data requests and coordinating with legal counsel and internal departments and external vendor to manage the subpoena lifecycle Daily management of the health system's Public Record Request website and coordinate with the appropriate stake holders and legal counsel to ensure compliance with regulatory requirements for responding to requests. Supporting the Vice President and Chief Compliance & Risk Officer with management of litigation claims and other legal matter logistics. Facilitates the claims filing and adjudication process with malpractice carriers and collaborates malpractice carriers with legal counsel and to ensure timely coordination of the discovery process for litigation. Works with legal counsel to coordinate meetings, interviews depositions with and support. staff and medical staff and provides logistical In addition to performing the essential functions listed below, may also be assigned other duties as required. Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.

Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.

**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** $94,400.00 - $155,800.00 **Target Openings** 1 **What 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 Specialty 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 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. + 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 creates Claim File Analysis (CFA) by adhering to quality standards. + Utilizes diary management system to ensure that all claims are handled timely. + At required time intervals, evaluate liability & damages exposure. + 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 manage both allocated and unallocated loss adjustment expenses. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + 5 years equivalent business experience. + Advanced level knowledge and skill in claim and litigation. + Basic working level knowledge and skill in various business line products. + Strong negotiation and customer service skills. + Skilled 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. + Openness to the ideas and expertise of others actively solicits input and shares ideas. + Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices. + Demonstrated coaching, influence and persuasion skills. + Advanced 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. + Can adapt to and support cultural change. + Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. + Analytical Thinking - Advanced. + Judgment/Decision Making - Advanced. + Communication - Advanced. + Negotiation - Advanced. + Insurance Contract. + Knowledge - Advanced. + Principles of Investigation - Advanced. + Value Determination - Advanced. + Settlement Techniques - Advanced. + Legal Knowledge - Advanced. + Medical Knowledge - Intermediate. **What is a Must Have?** + High School Degree or GED. + 3 years of liability claim handling experience and/or comparable litigation claim experience. + In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. + Generally, license(s) are required to be obtained within three months of starting the job. **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 ******************************************************** .

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

Full-time Description Claims Specialist - Job Description Manteca, CA - Onsite Who We Are Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada. With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers. Benefits · Comprehensive medical, dental, and vision insurance. · 401(k) plan with company match. · Company-paid Life and AD&D Insurance policies. · Paid vacation, sick leave, and holidays. The Opportunity We are seeking a Claims Specialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations. Essential Duties and Responsibilities • Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations. • Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim. • Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process. • Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation. • Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system. • Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues. Skills & Attributes • Strong analytical and investigative skills with excellent attention to detail. • Exceptional written and verbal communication skills. • Ability to manage multiple priorities in a fast-paced environment. • Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred. • Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable. • Strong organizational and problem-solving abilities with a customer service mindset. Requirements Minimum Requirements · Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred. · Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role. Compensation · Compensation: $20.00 - $24.00 per hour, based on experience and location. · Classification: Non-Exempt, subject to all applicable state and federal laws. Work Environment This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m. Physical Requirements: · Prolonged periods of sitting at a desk and working on a computer · Frequent walking throughout the facility and between departments as part of daily operational tasks · Ability to lift and/or move up to 20-25 pounds. · Ability to navigate each department and the company's facilities as needed. Equal Opportunity Employer Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law. Salary Description $20.00 - $24.00

Why Join Stand: At Stand, you'll help build a new class of global property protection. We use advanced physics and AI to model catastrophic risk at the asset level, then automate underwriting and mitigation before loss occurs. Insurance is simply the current delivery mechanism. The real product is a scalable risk engine. We stay when traditional insurers exit. We model what others approximate. And we build systems that change outcomes, not just prices. Background: The property insurance industry is built to price loss after it happens. It relies on coarse proxies, backward-looking data, and manual processes, then accepts damage as unavoidable. Stand takes a different approach. We simulate how real-world catastrophes affect individual properties, translate that into actionable decisions, and automate the business around it. The result is a platform that can underwrite what others can't and operate with far less friction. Role Summary: As Head of Claims at Stand Insurance, you will be responsible for managing the Claims lifecycle, end-to-end in conjunction with third party partners and the Operations team. Unlike many Claims roles, however, this role is unique in that it also provides an opportunity to be part of the solution in avoiding claims before they happen by working with mitigation and retrofitting vendors. By being involved in the building process before, during, and after a claim, you will be able to ensure we are fulfilling our promise of security to insureds in every facet. This role is great for a high energy, execution focused individual with experience in the most challenging property catastrophe markets. Core Responsibilities: Implement catastrophe response program and strategy for various catastrophe perils in conjunction with TPA partners Build core networks for programs such as water remediation, salvage and subrogation, legal defense, and other approved/recommended contractors that can provide high quality repairs for insureds while managing claim expense Maintain Claims compliance in all states and in all functional areas, such as claims handling practices, reporting, OFAC and CMS Medicare compliance, etc. Develop internal and external staffing, partnerships, and scaling Claims department for expansion of states and products Collaborate with cross-functional teams, including underwriting, product, and actuarial, to collaborate on policy language, underwriting guidelines, and claim reserving practices Help develop best in class wind mitigation vendor networks to help support insureds securing appropriate retrofitting quickly and affordably Work with Product and Technology teams to enhance technology for streamlined claim handling processes and create a seamless and transparent claim experience for insureds Must-Haves: 15+ years of property claims experience, predominantly in the personal lines space High-value Homeowners experience Experience in the Florida marketplace is strongly preferred, but generally shall have experience in one or more CATs in a leadership role Comfort working cross-functionally in a fast-paced, entrepreneurial environment Nice-to-Haves: Wildfire catastrophe experience Technical competencies and background in designing/working with teams to develop Claims Management software Compensation: The annual base salary range for full-time employees in this position is $150,000 to $210,000+ meaningful Equity Grant. Compensation decisions are dependent on several factors including, but not limited to, an individual's qualifications, location where the role is to be performed, internal equity, and alignment with market data. Additional Benefits: Comprehensive benefits including above-market Health, Dental, Vision Weekly lunch stipend Flexible time off 1-day a week WFH flexibility 401k plan Equal Opportunity Employment Stand is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status. We believe that diversity enriches the workplace, and we are committed to growing our team with the most talented and passionate people from every community. We are committed to providing reasonable accommodations for qualified individuals. If you require assistance Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Title: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16 Non-Exempt Hours per Week: 40 The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Possesses a strong work ethic and team player mentality. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third-party administrator. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $25.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities * Benefit interpretation and analysis of EOCs across multiple health plans * Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans * Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories * Analysis of authorization rules and Division of Financial Responsibility (DOFR) * Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators * Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation * Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution * Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary * Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) * Assist with maintenance of benefit requirements and configuration decisions and policies and procedures * Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems * Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems * Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance * Other duties as assigned Requirements * 5+ years of experience in benefits and claims in Managed Care, delegated model setting * Experience with benefit analysis and/or quality assurance * College degree in healthcare (preferred) or equivalent experience/knowledge * Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding * Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. * Experience with Epic Tapestry (preferred) * Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs * Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities * Knowledge of how benefit configuration relates to claims adjudication and payment processes. * Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. * Experience with testing, reviewing, and validating benefit plans * Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. * Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. * Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. * Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

Description:Claims Specialist - Job Description Manteca, CA - Onsite Who We Are Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada. With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers. Benefits · Comprehensive medical, dental, and vision insurance. · 401(k) plan with company match. · Company-paid Life and AD&D Insurance policies. · Paid vacation, sick leave, and holidays. The Opportunity We are seeking a Claims Specialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations. Essential Duties and Responsibilities • Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations. • Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim. • Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process. • Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation. • Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system. • Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues. Skills & Attributes • Strong analytical and investigative skills with excellent attention to detail. • Exceptional written and verbal communication skills. • Ability to manage multiple priorities in a fast-paced environment. • Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred. • Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable. • Strong organizational and problem-solving abilities with a customer service mindset. Requirements:Minimum Requirements · Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred. · Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role. Compensation · Compensation: $20.00 - $24.00 per hour, based on experience and location. · Classification: Non-Exempt, subject to all applicable state and federal laws. Work Environment This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m. Physical Requirements: · Prolonged periods of sitting at a desk and working on a computer · Frequent walking throughout the facility and between departments as part of daily operational tasks · Ability to lift and/or move up to 20-25 pounds. · Ability to navigate each department and the company's facilities as needed. Equal Opportunity Employer Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law.