Claim processor jobs in Pittsburgh, PA

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 $55,200.00 - $91,100.00 Target Openings 5 What Is the Opportunity? * There is also a potential for up to a $10,000 sign-on bonus! * Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner. In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. Travelers offers a hybrid work location model that is designed to support flexibility. What Will You Do? Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations. Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates. Determine claim eligibility, coverage, liability, and settlement amounts. Ensure accurate and complete documentation of claim files and transactions. Identify and escalate potential fraud or complex claims for further investigation. Coordinate with internal teams such as investigators, legal, and customer service, as needed. What Will Our Ideal Candidate Have? * Bachelor's Degree. * Three years of experience in insurance claims, preferably Auto claims. * Experience with claims management and software systems. * Strong understanding of insurance principles, terminology with the ability to understand and articulate policies. * Strong analytical and problem-solving skills. * Proven ability to handle complex claims and negotiate settlements. * Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. What is a Must Have? * High School Diploma or GED. * One year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program. 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 *********************************************************

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI

UPMC WorkPartners is hiring a full-time Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The selected candidate for this role will need to have their West Virginia workers comp adjuster license. The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers Compensation business unit. The Lost Time Claims Specialist II will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist II will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority within established best practices and performance standards. The Lost Time Claims Specialist II should possess strategic thought process skills to effectively and efficiently manage loss exposures. Responsibilities: * Assign medical or other experts to case and arrange for medical examinations when necessary. * Develop lost time claim disposition skills under limited direction of supervisor. * Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority. * Ensure proper referrals and timely updates to appropriate Reinsurer(s). * Actively participate in claim reviews with clients. * Timely analyze information in order to evaluate assigned claims to determine the extent of loss. * Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor. * Communicate claim status with the injured worker, clients, and broker as needed. * Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases. * Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level. * Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information. * Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases. * Appropriate state licensing to be obtained for assigned jurisdictions. * Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types. * Effectively and efficiently manage vendors and expenses. * Participate in monthly account renewal meetings as needed. * Mentoring and training new employees as appropriately assigned by management. * Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience. * Minimum of 2 years of Workers Compensation lost time claims handling experience. * West Virginia insurance adjuster license is highly preferred. * Experience with PA workers compensation is a bonus. * Intermediate knowledge of law and insurance regulations in various jurisdictions. * Demonstrated strong verbal and written communications skills. * Demonstrated strong analytical and decision making skills. * Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge. * Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation) and compensability decisions. Licensure, Certifications, and Clearances: * Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Company :Highmark Inc. : This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. ESSENTIAL RESPONSIBILITIES Coordinate, analyze, and interpret the benefits and claims processes for the department. Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. Work independently of support, frequently utilizing resources to resolve customer inquiries. Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. Gather information and develop presentation/training materials for support and education. Other duties as assigned or requested. EDUCATION Required High School or GED Substitutions None Preferred Associate's degree in or equivalent training in Business or a related field EXPERIENCE Required 3 years of customer service, health insurance benefits and claims experience. Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies PC Proficiency including Microsoft Office Products Ability to communicate effectively in both verbal and written form with all levels of employees Preferred Working knowledge of medical procedures and terminology. Complex claim workflow analysis and adjudication. ICD9, CPT, HPCPS coding knowledge/experience. Knowledge of Medicare and Medicaid policies LICENSES or CERTIFICATIONS Required None Preferred None SKILLS Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures The ability to take direction, to navigate through multiple systems simultaneously The ability to interact well with peers, supervisors and customers Understanding the implications of new information for both current and future problem-solving and decision-making Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems Ability to solve complex issues on multiple levels. Ability to solve problems independently and creatively. Ability to handle many tasks simultaneously and respond to customers and their issues promptly. Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $21.53 Pay Range Maximum: $32.30 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy PANTHERx is the nation's largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don't need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients. We are seeking team members who: Are inspired and compassionate problem solvers; Produce high quality work; Thrive in the excitement of the ever-challenging environment of modern medicine; and Are committed to achieving superior health outcomes for people living with rare and devastating diseases. At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases. Join the PANTHERx team, and define your own RxARE future in healthcare! Location: Pittsburgh, PA; Remote with occasional on-site work requirements Classification: Non-Exempt Status: Full-Time Reports To: Supervisor, Claims Purpose: The Claim Analyst (Mid Shift) verifies patient pharmacy and medical claims accurately and quickly. This role liaises between patients, insurance companies, and government agencies to ensure patient receives medication accurately and timely and the appropriate entity is being billed. To accommodate business and patient services, this position will be required to work a full-time schedule with a shift of either 9:30AM-6:30PM or 10AM-6:30PM, Monday through Friday. Responsibilities: Verifies patient pharmacy and medical coverage & processing info. Abilities to process pharmacy claims on the patient's behalf through a pharmacy benefit system. Abilities to verify medical benefits accurately on patient's behalf. Obtains authorizations & overrides as needed. Applies patients for copay cards and/or assistance programs. Discusses with patient to review patient financial responsibility, obtain patient consent and payment. Ensures proper shipment set up. Works special projects. Attends staff meetings. Other tasks as assigned. Required Qualifications: High school diploma or general education degree (GED). Minimum 2 years' experience processing pharmacy claims. Strong written and verbal communication skills necessary to convey ideas professionally and effectively. Ability to multitask. Proficient with EDS billing systems, Excel, and Word. Preferred Qualifications: Experience or knowledge within the healthcare industry, particularly a mail order or specialty pharmacy Experience with CPR+ Work Environment: PANTHERx Rare Pharmacy offers flexibility only to eligible employees to work hybrid or remotely without compromising work performance, productivity, or team collaboration. This role routinely uses standard office equipment such as computers and phones. Physical Demands: While performing the duties of this job, the employee is regularly required to talk, hear, and see. The employee frequently is required to sit, stand, and walk; use hands and fingers, handle or feel; reach with hands and arms and see a computer screen. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job. Benefits: Hybrid, remote and flexible on-site work schedules are available, based on the position. PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program! Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees. Of course we offer paid holidays too! Equal Opportunity: PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.

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 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$48,700.00 - $80,400.00Target Openings1What Is the Opportunity?LOCATION REQUIREMENT: This field position services Insureds/Agents in the Pittsburgh, PA area. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Ideal locations include Allegheny County, PA. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. *You will be issued a company vehicle for this position.* This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.What Will You Do? Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. The on the job training includes practice and execution of the following core assignments: Handles 1st party property claims of moderate severity and complexity as assigned. Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic Valid passport preferred. What is a Must Have? High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. Valid driver's license - required. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

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

UPMC WorkPartners is hiring a full-time Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The selected candidate for this role will need to have their West Virginia workers comp adjuster license. The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers Compensation business unit. The Lost Time Claims Specialist II will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist II will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority within established best practices and performance standards. The Lost Time Claims Specialist II should possess strategic thought process skills to effectively and efficiently manage loss exposures. Responsibilities: + Assign medical or other experts to case and arrange for medical examinations when necessary. + Develop lost time claim disposition skills under limited direction of supervisor. + Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority. + Ensure proper referrals and timely updates to appropriate Reinsurer(s). + Actively participate in claim reviews with clients. + Timely analyze information in order to evaluate assigned claims to determine the extent of loss. + Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor. + Communicate claim status with the injured worker, clients, and broker as needed. + Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases. + Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level. + Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information. + Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases. + Appropriate state licensing to be obtained for assigned jurisdictions. + Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types. + Effectively and efficiently manage vendors and expenses. + Participate in monthly account renewal meetings as needed. + Mentoring and training new employees as appropriately assigned by management. + Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience. + Minimum of 2 years of Workers Compensation lost time claims handling experience. + West Virginia insurance adjuster license is highly preferred. + Experience with PA workers compensation is a bonus. + Intermediate knowledge of law and insurance regulations in various jurisdictions. + Demonstrated strong verbal and written communications skills. + Demonstrated strong analytical and decision making skills. + Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge. + Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation) and compensability decisions. Licensure, Certifications, and Clearances: + Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Job Details Blackburn's Corporate - Tarentum, PA InsuranceDescription Job Opening: Claims Processing Specialist at Blackburn's Are you a detail-oriented professional with a passion for the healthcare industry? Blackburn's is looking for a Claims Processing Specialist to join our Corporate Claims department and perform third-party medical billing functions. If you thrive in a fast-paced environment and possess excellent organizational and communication skills, this could be the perfect opportunity for you! What You'll Do: Manage and verify third-party medical claims for accuracy and compliance. Collaborate with cross-functional teams to resolve billing discrepancies and insurance denials. Process claims efficiently while adhering to strict filing deadlines. Contribute to the improvement of billing processes to reduce denials and increase efficiency. Utilize your strong communication skills to work with internal teams and external clients. Why Join Us? At Blackburn's, we're committed to creating a positive impact in the healthcare industry by delivering quality products and services. As part of our team, you'll have access to in-house training, opportunities for career growth, and a collaborative work environment. We offer competitive pay, benefits, and the chance to be part of a company that values its employees. Work Hours: 8:00 a.m. - 4:30 p.m. or 8:30 a.m. - 5:00 p.m. If you have a passion for medical billing and enjoy working in a dynamic, fast-paced environment, we'd love to hear from you! Apply today and join us in making a difference at Blackburn's! Qualifications What We're Looking For: Prior experience in healthcare-related industries, preferably with third-party medical billing. Strong attention to detail, time management, and the ability to juggle multiple tasks. Excellent interpersonal skills, with the ability to work both independently and as part of a team. Proficiency in Microsoft Office, with knowledge of Word and Excel. Ability to work independently, prioritize workload, and adapt to changing environments.

Proven to Perform. From the edges of space to the bottoms of ocean, our materials are proven to perform -- and so is our team. We're hiring high performers as proven as our products. Join us. ATI is seeking to hire a Material Testing and Certification Specialist to support our Specialty Rolled Products Material certification team and test sample flow process in Washington, PA. This position will be focused on the efficiency of the material certification and test process ensuring adherence to business shipping deadlines. The individual will also be responsible for providing instructions and acting as a resource for the Washington Sample Cutting Prep Lab. Essential Job Duties Perform material certifications across all product lines in Washington. Act as back-up for Monaca, PA certification team, as needed Instruct prep lab employees with prioritization of work Track flow of test samples through the sample cutting prep lab Back-up sample cutting prep lab supervisor, as needed Package, track, and expedite test / customer samples, as needed Coordinate testing between ATI and third-party labs to ensure adherence to operating plan while minimizing testing costs Troubleshoot and resolve issues that arise with test sample flow and nonconforming test results Verify, update and optimize test lotting to meet customer orders for certification Support development / review of customer specifications and society specifications for testing requirements Ensure purchase orders are current and up to date for outside testing vendors Ensure safety and housekeeping procedures are adhered to

Proven to Perform. From the edges of space to the bottoms of ocean, our materials are proven to perform -- and so is our team. We're hiring high performers as proven as our products. Join us. ATI is seeking to hire a Material Testing and Certification Specialist to support our Specialty Rolled Products Material certification team and test sample flow process in Washington, PA. This position will be focused on the efficiency of the material certification and test process ensuring adherence to business shipping deadlines. The individual will also be responsible for providing instructions and acting as a resource for the Washington Sample Cutting Prep Lab. Essential Job Duties Perform material certifications across all product lines in Washington. Act as back-up for Monaca, PA certification team, as needed Instruct prep lab employees with prioritization of work Track flow of test samples through the sample cutting prep lab Back-up sample cutting prep lab supervisor, as needed Package, track, and expedite test / customer samples, as needed Coordinate testing between ATI and third-party labs to ensure adherence to operating plan while minimizing testing costs Troubleshoot and resolve issues that arise with test sample flow and nonconforming test results Verify, update and optimize test lotting to meet customer orders for certification Support development / review of customer specifications and society specifications for testing requirements Ensure purchase orders are current and up to date for outside testing vendors Ensure safety and housekeeping procedures are adhered to

Proven to Perform. From the edges of space to the bottoms of ocean, our materials are proven to perform -- and so is our team. We're hiring high performers as proven as our products. Join us. ATI is seeking to hire a Material Testing and Certification Specialist to support our Specialty Rolled Products Material certification team and test sample flow process in Washington, PA. This position will be focused on the efficiency of the material certification and test process ensuring adherence to business shipping deadlines. The individual will also be responsible for providing instructions and acting as a resource for the Washington Sample Cutting Prep Lab. Essential Job Duties * Perform material certifications across all product lines in Washington. Act as back-up for Monaca, PA certification team, as needed * Instruct prep lab employees with prioritization of work * Track flow of test samples through the sample cutting prep lab * Back-up sample cutting prep lab supervisor, as needed * Package, track, and expedite test / customer samples, as needed * Coordinate testing between ATI and third-party labs to ensure adherence to operating plan while minimizing testing costs * Troubleshoot and resolve issues that arise with test sample flow and nonconforming test results * Verify, update and optimize test lotting to meet customer orders for certification * Support development / review of customer specifications and society specifications for testing requirements * Ensure purchase orders are current and up to date for outside testing vendors * Ensure safety and housekeeping procedures are adhered to Basic Qualifications * Experience in manufacturing operations or working in a shopfloor environment Preferred Qualifications * Bachelor's degree Knowledge, Skills, and Abilities * Computer experience and working knowledge with Microsoft Office Software - Outlook, Word, Excel, and job/company related systems * Highly motivated with exceptional ability to collect, organize, analyze and report data * Ability to work in a fast-paced environment while meeting deadlines is essential. We thrive when the expectations are great, and the barriers are high. We're solving the world's most difficult challenges through materials science. Our advanced, integrated process technologies and proven performers give us a tremendous competitive advantage. When customers systems need to fly higher, dig deeper, stand stronger, and last longer -- anywhere on, above or below the earth -- ATI is proven to perform. * It is ATI's policy to not provide immigration sponsorship for any of the company's positions. ATI and its subsidiary companies will provide equal employment opportunities to all applicants without regard to applicant's race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, veteran status, disability status, or any other status protected be federal or state law. The company will provide reasonable accommodations to allow an applicant to participate in the hiring process if so requested.

Claims Auditor I, II and Senior Location : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Claims Auditor I is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The Claims Auditor II is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The Claims Auditor Senior is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. How you will make an impact : * Performs audits of high dollar claims. * Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. * Contacts others to obtain any necessary information. * Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. * Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. * Refers overpayment opportunities to Recovery Team. * Claims Auditor II - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. * Claims Auditor Senior - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. Minimum Requirements : * Claims Auditor I : Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. * Claims Auditor II : Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. * Claims Auditor Senior : Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: * Stop loss claims experience highly preferred. * Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. * Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. * Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CLM > Claims Support Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReview and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. May provide job shadowing to lesser experience staff. Utilize all resource materials to manage job responsibilities. Required Qualifications2+ years medical claim processing experience. Experience in a production environment. Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Effective communications, organizational, and interpersonal skills. Preferred QualificationsDG system claims processing experience. Associate degree preferred. EducationHigh School Diploma or GED. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

**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** $55,200.00 - $91,100.00 **Target Openings** 5 **What Is the Opportunity?** *There is also a potential for up to a $10,000 sign-on bonus! * Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner. In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. Travelers offers a hybrid work location model that is designed to support flexibility. **What Will You Do?** Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations. Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates. Determine claim eligibility, coverage, liability, and settlement amounts. Ensure accurate and complete documentation of claim files and transactions. Identify and escalate potential fraud or complex claims for further investigation. Coordinate with internal teams such as investigators, legal, and customer service, as needed. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + Three years of experience in insurance claims, preferably Auto claims. + Experience with claims management and software systems. + Strong understanding of insurance principles, terminology with the ability to understand and articulate policies. + Strong analytical and problem-solving skills. + Proven ability to handle complex claims and negotiate settlements. + Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. **What is a Must Have?** + High School Diploma or GED. + One year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program. **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 ******************************************************** .

Company :Highmark Inc. : This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. ESSENTIAL RESPONSIBILITIES Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. Maintains accurate claim records. Other duties as assigned or requested. EDUCATION Required High School Diploma/GED Substitutions None Preferred Bachelor's degree EXPERIENCE Required 5 years of relevant, progressive experience in health insurance claims 3 years of prior experience processing 1st dollar health insurance claims 3 years of experience with medical terminology Preferred: 3 years of experience in a Stop Loss Claims Analyst role. SKILLS Ability to communicate concise accurate information effectively. Organizational skills Ability to manage time effectively. Ability to work independently. Problem Solving and analytical skills. Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $22.71 Pay Range Maximum: $35.18 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR 38wbewsfq6

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Candidates should reside in Cambria, Indiana or Westmoreland County Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-AT1 #LI-Hybrid

**Claims Auditor I, II and Senior** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ The **Claims Auditor I** is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The **Claims Auditor II** is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The **Claims Auditor Senior** is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. **How you will make an impact :** + Performs audits of high dollar claims. + Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. + Contacts others to obtain any necessary information. + Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. + Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. + Refers overpayment opportunities to Recovery Team. + **Claims Auditor II** - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. + **Claims Auditor Senior** - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. **Minimum Requirements :** + **Claims Auditor I :** Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. + **Claims Auditor II :** Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. + **Claims Auditor Senior :** Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities & Experiences:** + Stop loss claims experience highly preferred. + Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. + Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. + Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.