Claim processor jobs in Portland, ME

At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: * Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs * Consistently adhere to the documented workflow guidelines and established procedures. * Maintain required levels of confidentiality * Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education * Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines * Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations * Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures * Assist in the subrogation process to recover money from third parties * Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD * Document claim file actions and telephone conversations appropriately * Refer claim activity outside authority level to Supervisor/Manager for review * Proactively communicate with claimants, policyholders and physicians to resolve investigations issues * Establish, communicate and manage claimant and policyholder expectations * Utilize most efficient means to obtain claim information * Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations * Respond to customer service issues within required timeframes * Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures * Support relationships with technical resources to achieve appropriate outcomes * Meet or exceed departmental service, quality and production objectives * Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies * All other duties as assigned REQUIREMENTS: * BA/BS or equivalent combination of education and experience * 0-2+ years of experience in managing Short Term Disability claims with first pay authority * Ability to fluently speak and write Spanish a plus * Excellent customer service skills * Excellent math and calculation skills * Good decision-making skills * Ability to analyze complex claim information * Working knowledge of Microsoft Excel and Word * High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

All Boston Mutual employees who interact with our policyholders, our producers, and our BML associates embrace the principles of our brand and service philosophy. We are all brand ambassadors. Both our words and our behaviors matter. We share a common service philosophy and pride ourselves in living the BML brand promises every day, one interaction at a time. The following statements represent what Boston Mutual stands “FOR” - it is what makes us different and better in the market we serve. We are FOR being a progressive life insurance company offering financial peace of mind to working Americans and their families. We are FOR providing practical and affordable products designed for those we serve. We are FOR making it easy to secure a level of financial protection with a portfolio of products - beginning with life insurance. We are FOR providing a personalized customer experience to our policyholders and producers. We are FOR acting in the best interests of our policyholders, producers, employees and the communities in which we live and serve - representing the goodness of mutuality in all we do. We do our best to: Demonstrate a desire to assist Listen for understanding and respond empathetically Explain things in a manner that is easy to understand Be knowledgeable students of our business Take full ownership to resolve questions and issues Be professional, polite and courteous Leave our customers and associates “better than where we found them” Statement of Position The Life Claim Examiner reports directly to the Life Claim Manager. The Life Claim Examiner is responsible for managing and processing all assigned claims with adherence to company policies and contract provisions in full accordance of the law while demonstrating the highest levels of service professionalism in all they do. The Life Claim Examiner is expected to: Manage their assigned caseload of Life insurance claims and ensures the accuracy and completeness of submitted claims. Processes assigned claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality/production standards. Review and process claims, evaluate medical records, and request additional information when needed. Obtains claim information by communicating effectively with internal/external stakeholders verbally and in written form while maintaining a professional demeanor. Interpret and evaluate policy/contract revisions. Review pending claims on a monthly basis. Perform other duties as assigned. JOB REQUIREMENTS AND QUALIFICATIONS Education: High School Diploma, GED or equivalent required. Medical terminology and/or insurance experience preferred. Experience: Claim examiner: Minimum of 1 year of business/office experience. Sr. Claim Examiner: Minimum of 2 years life/medical claims experience required. Knowledge Requirements: Strong business knowledge Excellent written/verbal communication skills. Strong organizational skills that reflect ability to perform and prioritize a high volume of task. Multitasks seamlessly with excellent attention to context, substance, and detail while meeting goals and strict deadlines. Excellent interpersonal skills and the ability to effectively build and extend relationships. Working knowledge of desktop applications such as Outlook, Word and Excel. Certifications/Licensures: N/A ADDITIONAL INFORMATION Regular Working Conditions (Desk job with occasional walking, use of computer with hand and finger motions, close and distance vision, minimal noise level and no exposure to weather conditions) Prolonged Standing Frequent Walking or Stooping Heavy Equipment or Machinery Operation Heavy Lifting Increased Noise Level Exposure to Weather Conditions Travel Required “On Call” Hours Required Other Information:

Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs. Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district. Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

Job Details Manchester, NH Fully RemoteClaim Examiner The Claims Examiner Reviews, evaluates, and processes insurance claims and makes recommendations for resolution; Examines and authorizes insurance claims investigated by insurance adjusters; Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim; Communicates with agents, claimants, and policy holders; Determines settlement according to organization practices and procedures.; Works on projects/matters of limited complexity in a support role. This position manages general liability, bodily injury, property damage, personal/advertising injury, auto and other miscellaneous claims. The Claims Examiner will analyze, investigate and resolve complex claim issues, including coverage, liability and damages. The position requires familiarity with regulatory compliance requirements and tort law. Responsibilities Ensure appropriate investigation of the underlying facts and circumstances is carried out in a timely manner, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed. Recognizing exposures and ensuring reserving is appropriate and timely. Evaluating coverage issues and risk transfer opportunities. Effectively communicate exposures both internally and externally. Overall responsibility for formulating proper resolution strategy to ensure best total outcome. Position may require periodic travel to attend meditations, trials and/or other related meetings. Perform other duties as assigned Qualifications Requirements Bachelor's degree preferred CPCU or AIC Certification (Preferred) Experience handling large complex commercial casualty claims with 2-8 years of commercial casualty claim adjusting experience handling primary and excess general liability, auto and personal injury claims. Experience in claims coverage analysis. Ability to approach every task in a meticulous and thorough manner, documenting actions and communications, prioritizing, maintaining schedules; paying attention to detail and striving for accuracy at all times; identifying and meeting all deadlines. Understanding of legal procedures, regulatory compliance and states' statutes. Strong oral and written communication skills with the ability to communicate professionally at all levels within and outside the organization. Insurance designations a plus. Strong computer skills including Microsoft Office Word, Outlook and Excel.

Job Description At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs Consistently adhere to the documented workflow guidelines and established procedures. Maintain required levels of confidentiality Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures Assist in the subrogation process to recover money from third parties Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD Document claim file actions and telephone conversations appropriately Refer claim activity outside authority level to Supervisor/Manager for review Proactively communicate with claimants, policyholders and physicians to resolve investigations issues Establish, communicate and manage claimant and policyholder expectations Utilize most efficient means to obtain claim information Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations Respond to customer service issues within required timeframes Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures Support relationships with technical resources to achieve appropriate outcomes Meet or exceed departmental service, quality and production objectives Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies All other duties as assigned REQUIREMENTS: BA/BS or equivalent combination of education and experience 0-2+ years of experience in managing Short Term Disability claims with first pay authority Ability to fluently speak and write Spanish a plus Excellent customer service skills Excellent math and calculation skills Good decision-making skills Ability to analyze complex claim information Working knowledge of Microsoft Excel and Word High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 1 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in South Eastern MA. The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory. Experienced candidates will also be considered. **What Will You Do?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic. + Verbal and written communication skills -Intermediate. + Attention to detail ensuring accuracy - Basic. + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic. + Analytical Thinking - Basic. + Judgment/ Decision Making - Basic. + Valid passport. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. + Valid driver's license. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide: + Award-winning culture + Inclusion and diversity as a priority + Performance Based Incentive Plans + Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability + Generous PTO (including paid time to volunteer!) + Up to 9.5% 401(k) employer contribution + Mental health support + Career advancement opportunities + Student loan repayment options + Tuition reimbursement + Flexible work environments **_*All the benefits listed above are subject to the terms of their individual Plans_** **.** And that's just the beginning... With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! **General Summary:** Summary Minimum starting hourly rate is $22.12- $24.04 Training start date: Jan 2026 We are looking for candidates to fill various roles related to managing leave requests and disability claims. When you apply, you'll be considered for positions such as Integrated Paid Leave Specialist, STD Benefits Specialist Trainee, Associate Leave Specialist, Eligibility Specialist and Associate Life Event Specialist. Your placement will depend on your qualifications and role availability. These positions help ensure that our company complies with leave laws and policies while providing top-notch service to our customers. Each of these roles comes with a comprehensive training program, ensuring you gain all the knowledge and expertise needed. These roles are perfect for those who have strong analytical skills, like to learn, and want to help the working world thrive. Join us to make a meaningful impact and grow your career. This is a main campus based position, applicants will work in the Chattanooga, TN or Portland, ME office 3-5 days a week in office required. **Principal Duties and Responsibilities** + Handle leave, short-term disability (STD), or paid leave claims efficiently and accurately. + Determine if employees are eligible for different types of leave, such as FMLA, PFML, and corporate-paid plans. + Have an advanced understanding of compliance and regulations and use this to make fair decisions about eligibility and benefits. + Create necessary communications to comply with federal, state, and company leave policies. + Review medical certifications and other documents, consulting with internal teams as needed. + Stay updated on changes in leave laws and industry practices. + Maintain good relationships with employer contacts, HR administrators, and employees. + Answer questions and resolve issues for employees and employers promptly. + Work with other departments to ensure smooth operations. + Meet standards for accuracy, quality, and service in managing claims and leaves. + Provide excellent customer service by processing claims promptly and addressing inquiries quickly. **Job Specifications** + A 4-year degree or relevant experience is preferred. + Experience in medical, disability claims, or leave management is a plus. + Strong decision-making, analytical, and problem-solving abilities. + Ability to use independent judgment and think critically in making decisions. + Excellent interpersonal and communication skills (phone, email, and written). + Proficiency with Windows and basic computer skills (Word, Excel, Access). + Detail-oriented with strong organizational skills. + Ability to perform in a fast-paced environment while managing multiple tasks and priorities + Ability to make fair decisions quickly and efficiently. + Self-motivated and able to work independently and as part of a team. ~IN2 \#LI-MP1 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $36,000.00-$62,400.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum

011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time._** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits. This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and research, as necessary on all new and revised coding logic, related Medicare/Medicaid policies for review/approval through the Payment Integrity governance process. **Supervision Exercised:** + No, this position does not have direct reports. **Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration requirements for Optum CES and Zelis edits. + Quarterly and Annual review and research, as necessary on all new CPT and HCPCS codes for coding logic, related Medicare/Medicaid policies to make recommend reimbursement determinations. + Analyze, measure, manage, and report outcome results on edits implemented. + Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to industry standard coding regulations, and make recommendations based on new/revised coding edits for presentation to Payment Integrity committee meetings. + Analyze, measure, manage, and report outcome results on edits implemented. + Use and maintain the rules and policies specific to CES and Zelis. + Query and analyze claims to address any negative editing impacts and create new opportunities for savings based on provider billing trends + Liaison between business partners and vendors; bringing and interpreting business requests, providing solutioning options and documentation, developing new policies based on State and Federal requirements, host meetings, and managing projects to completion + Define business requests received, narrow the scope of the request based on business needs and requirements, provider resolution option based on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System) with BPaaS vendor and other PI partners, perform user acceptance testing, and analyze post production reports for issues + Support collaboration between PI/Claims and other internal stakeholders related to the identification and implementation of cost-savings initiatives specific to edits. **Working Conditions:** + Standard office conditions. Remote opportunity. **Other:** + Standard office equipment + None/stationary **Required Education (must have):** + Bachelor's Degree or Equivalent experience Ideal Candidate to have the one or all of the required certification OR willing to get certified within 1 year of employment - + Certified Professional Coder (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters Degree **Required Experience (must have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims Editing System (CES), Zelis, Lyric or other editing tools + Extensive knowledge and experience in Healthcare Revenue Integrity, Payment Integrity, and Analytics + 5+ years of Facets Claims Processing System **Required Knowledge, Skills & Abilities (must have):** + Knowledge and experience of claim operations, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare) + Medical Coding, Compliance, Payment Integrity and Analytics + Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies (i.e . Center for Medicare & Medicaid Services (CMS) & MA Medicaid, Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) both practitioner and facility, modifier to procedure validation, and other CMS and American Medical Association (AMA) guidelines, etc.) + Advanced experience of medical terminology and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims' processing policies, coding principals and payment methodologies + Ability to work cross functionally to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives + Ability to plan, organize, and manage own work; set priorities and measure performance against established benchmarks + Ability to communicate and work effectively at multiple levels within the company + Customer service orientation; positive outlook, self-motivated and able to motivate others + Strong work ethic; able to solve problems and overcome challenges **Required Language (must have):** + English **Compensation Range/Target: $64,000 - $96,000** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. EEO is The Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.

Duties/Responsibilities: • Conduct file reviews for compliance with the applicable subsidy type (S8, LIHTC, etc.). • Prepares reports that summarizes items of non-compliance and works in conjunction with property staff to correct identified deficiencies. • Meets with residents and applicants to perform Initial, Annual or Interim interviews for the applicable subsidy type (S8, LIHTC, etc.). • Processes required verifications that are necessary to complete resident and applicant certifications. • Provides Regional Property Manager with file reviews and suggests items for employee training deficiencies. • Reviews quarterly/monthly EIV reports for accuracy and assist property staff with resolving discrepancies. • Prepare monthly/quarterly/annual LIHTC reports (i.e. qualified basis tracking) as required by state monitors and syndicators for submission to the Director of Compliance. • Reviews asset verifications for certifications that involve real estate and/or investment income for submission and final review. • Assists staff with monthly voucher submissions, HAP payment errors and posting/reconciling within One Site. • Other duties as assigned. Qualifications: • Strong knowledge of affordable housing programs, to include Section 8/236; LIHTC; EIV and HUD Secure Systems; Fair Housing & Section 504 compliance. • Affordable Housing certifications; COS (or equivalent), C3P, HCCP or nationally recognized certification is required. • Three to five years of directly related experience as a property manager or compliance analyst/monitor required. • Strong written and verbal communication skills are required. • High level of organization and attention to detail is a must. • Ability to manage multiple priorities and deadlines. • Good Microsoft Office (Word, Excel) skills are required. Strong knowledge of OneSite, Yardi or Boston Post software highly desired.

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of moderate to high complexity and moderate to high exposure claims which can be subject to disputes that must be resolved in mediation or litigation. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. The position will have increased responsibility for decision making within their authority and work with minimal oversight and will provide training and be a technical referral point for other team members. Job Responsibilities * Experience handling moderate to high exposure Environmental site pollution and contractors pollution BI and PD claims and/or a legal background as a practicing attorney with litigation or coverage experience is required * Analyzes complex coverage issues and communicates coverage positions * Conducts, coordinates, and directs investigation into loss facts and extent of damages * Directs and monitors assignments to outside counsel and experts * Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure * Sets reserves within authority or makes claim recommendations concerning reserve changes to manager * Negotiates and settles claims either directly or indirectly * Prepares reports by collecting and summarizing information * Adheres to Fair Claims Practices regulations * Participates in special projects and assists other team members as needed * Travel to mediations, trials, and conferences as required Education * Bachelor's Degree required * Juris Doctor optional Certification * Must have or be eligible to receive claims adjuster license. * Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) Work Experience * 4+ years of claims handling experience or equivalent combination of education and experience * Experience handling environmental claims US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Pay information: The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $73,100 - $107,250 with a 15% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

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.

Job Type: Permanent Build a brilliant future with Hiscox Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist! Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations: West Hartford, CT (preferred) Atlanta, GA Boston, MA Chicago, IL Los Angeles, CA Manhattan, NY About the Hiscox Claims team: The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners. The role: The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible. What you'll be doing as the Complex Claims Specialist: Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to: Reviewing and analyzing claim documentation and legal filings Drafting coverage analyses for tech E&O, first and third party cyber claims Strategizing and maximizing early resolution opportunities Monitoring litigation and managing local defense and breach counsel Attending mediations and/or settlement conferences, either in person or by phone as appropriate Smartly managing and tracking third-party vendor and service provider spend Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager Liaising directly on daily basis with insureds and brokers Maintaining timely and accurate file documentation/information in our claims management system Our must-haves: 5+ years of professional lines claims handling experience A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred What Hiscox USA Offers Competitive salary and bonus (based on personal & company performance) Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care) Company paid group term life, short-term disability and long-term disability coverage 401(k) with competitive company matching 24 Paid time off days with 2 Hiscox Days 10 Paid Holidays plus 1 paid floating holiday Ability to purchase 5 additional PTO days Paid parental leave 4 week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox USA Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range $140,000 - $155,000 (Boston, Manhattan, West Hartford) Salary range $125,000-$135,000 (Chicago, Atlanta) The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-AJ1 Work with amazing people and be part of a unique culture

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Waltham, MA. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $25.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion

Job Description Our role as a Field Claims Representative will be responsible for the investigation, evaluation and settlement of assigned claims involving 1st Party Homeowner and Commercial Property claims. This role is a field-based position and will require travel to loss sites to evaluate the damages. This also includes special investigation activities with an emphasis on investigating possible fraudulent activity. This is a field based position, travel will be required within Southern Maine, with occasional travel to other areas as required. Responsibilities Field appraise losses of all types for both personal lines and commercial lines claims Take loss reports directly from insureds and/or claimants and/or their representatives. Appropriately handle incoming correspondence on assigned claim files. Investigate assigned claims - confirm coverage - verify damages. Effectively handle portions of claim investigations principally through on-site investigations, as warranted. Evaluate and settle assigned claims based upon the results of the investigation. A strong ability to work independently. Other related duties as assigned by supervisor including but not limited to aiding during CATs or other unusual spikes in claim volume. Requirements Bachelor's degree preferred or several years of direct experience 5-7 years of experience handling Property Claims; Commercial Lines experience a plus. Strong understanding of personal and commercial lines policy forms and coverage analysis. Multi-line adjuster's license as required in our operating territories. Demonstrated proficiency in writing detailed structural cost of repair/replacement estimates in Xactimate estimating system and proficient in PC Windows environment. Demonstrated proficiency in investigating, evaluating and settling contents claims. Excellent understanding and skill level of claim handling and customer service. Possess or has ability to timely secure and maintain required multiline adjuster licenses. Knowledge of policy contracts, insurance laws, regulations, and the legal environment in which we operate. Outside/Field Adjusters - ability to view damages and prepare estimates based on their inspection of the damaged property. Benefits At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness. Why Concord Group Insurance Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont. At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do. Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve. Compensation We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities. Equal Employment Opportunity The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on 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. The Concord Group participates in E-Verify

Safety Insurance is proud to be one of the leading property and casualty insurance providers in Massachusetts. We are committed to supporting independent agents and their customers through our unwavering dedication to excellence. Our success is built on a simple philosophy: deliver the highest quality insurance products at competitive rates while providing exceptional service at every step. At Safety Insurance, we don't just offer jobs - we offer careers that are challenging, fulfilling, and designed to grow with you. Our people are our greatest asset. A diverse workforce makes us stronger, more innovative, and better equipped to serve our customers. At Safety, we empower our employees to be their best by fostering an inclusive environment and offering resources that support their careers, education, and families. We also understand the importance of work-life balance. That's why we offer hybrid work options, flexible schedules, and a 37.5-hour workweek. Conveniently located in the heart of Boston's financial district, our downtown office is a positive space where employees can stay connected to both each other and the pulse of the city. Safety's benefits go beyond the basics. In addition to competitive salaries, our comprehensive benefits package includes: * 3 weeks accrued paid time off + 11 paid holidays per year * Health insurance (medical, dental, vision) * Annual 401(k) Employer Contribution (up to 8% of your base salary) * 100% tuition reimbursement * Free on-site fitness center * Complimentary coffee and breakfast service * Hybrid work schedules * Working Advantage Discount Program * Employee Assistance Program * …and much more! Join Safety Insurance and discover a career that's built to support your success - both personally and professionally.

Job Details Manchester, NH Fully RemoteDescription The Claims Examiner Reviews, evaluates, and processes insurance claims and makes recommendations for resolution; Examines and authorizes insurance claims investigated by insurance adjusters; Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim; Communicates with agents, claimants, and policy holders; Determines settlement according to organization practices and procedures.; Works on projects/matters of limited complexity in a support role. This position manages general liability, bodily injury, property damage, personal/advertising injury, auto and other miscellaneous claims. The Claims Examiner will analyze, investigate and resolve complex claim issues, including coverage, liability and damages. The position requires familiarity with regulatory compliance requirements and tort law. Responsibilities Ensure appropriate investigation of the underlying facts and circumstances is carried out in a timely manner, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed. Recognizing exposures and ensuring reserving is appropriate and timely. Evaluating coverage issues and risk transfer opportunities. Effectively communicate exposures both internally and externally. Overall responsibility for formulating proper resolution strategy to ensure best total outcome. Position may require periodic travel to attend meditations, trials and/or other related meetings. Perform other duties as assigned Qualifications Requirements Bachelor's degree preferred CPCU or AIC Certification (Preferred) Experience handling large complex commercial casualty claims with 2-8 years of commercial casualty claim adjusting experience handling primary and excess general liability, auto and personal injury claims. Experience in claims coverage analysis. Ability to approach every task in a meticulous and thorough manner, documenting actions and communications, prioritizing, maintaining schedules; paying attention to detail and striving for accuracy at all times; identifying and meeting all deadlines. Understanding of legal procedures, regulatory compliance and states' statutes. Strong oral and written communication skills with the ability to communicate professionally at all levels within and outside the organization. Insurance designations a plus. Strong computer skills including Microsoft Office Word, Outlook and Excel.

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide: * Award-winning culture * Inclusion and diversity as a priority * Performance Based Incentive Plans * Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability * Generous PTO (including paid time to volunteer!) * Up to 9.5% 401(k) employer contribution * Mental health support * Career advancement opportunities * Student loan repayment options * Tuition reimbursement * Flexible work environments * All the benefits listed above are subject to the terms of their individual Plans. And that's just the beginning… With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! General Summary: Summary Minimum starting hourly rate is $22.12- $24.04 Training start date: Jan 2026 We are looking for candidates to fill various roles related to managing leave requests and disability claims. When you apply, you'll be considered for positions such as Integrated Paid Leave Specialist, STD Benefits Specialist Trainee, Associate Leave Specialist, Eligibility Specialist and Associate Life Event Specialist. Your placement will depend on your qualifications and role availability. These positions help ensure that our company complies with leave laws and policies while providing top-notch service to our customers. Each of these roles comes with a comprehensive training program, ensuring you gain all the knowledge and expertise needed. These roles are perfect for those who have strong analytical skills, like to learn, and want to help the working world thrive. Join us to make a meaningful impact and grow your career. This is a main campus based position, applicants will work in the Chattanooga, TN or Portland, ME office 3-5 days a week in office required. Principal Duties and Responsibilities * Handle leave, short-term disability (STD), or paid leave claims efficiently and accurately. * Determine if employees are eligible for different types of leave, such as FMLA, PFML, and corporate-paid plans. * Have an advanced understanding of compliance and regulations and use this to make fair decisions about eligibility and benefits. * Create necessary communications to comply with federal, state, and company leave policies. * Review medical certifications and other documents, consulting with internal teams as needed. * Stay updated on changes in leave laws and industry practices. * Maintain good relationships with employer contacts, HR administrators, and employees. * Answer questions and resolve issues for employees and employers promptly. * Work with other departments to ensure smooth operations. * Meet standards for accuracy, quality, and service in managing claims and leaves. * Provide excellent customer service by processing claims promptly and addressing inquiries quickly. Job Specifications * A 4-year degree or relevant experience is preferred. * Experience in medical, disability claims, or leave management is a plus. * Strong decision-making, analytical, and problem-solving abilities. * Ability to use independent judgment and think critically in making decisions. * Excellent interpersonal and communication skills (phone, email, and written). * Proficiency with Windows and basic computer skills (Word, Excel, Access). * Detail-oriented with strong organizational skills. * Ability to perform in a fast-paced environment while managing multiple tasks and priorities * Ability to make fair decisions quickly and efficiently. * Self-motivated and able to work independently and as part of a team. ~IN2 #LI-MP1 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $36,000.00-$62,400.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum

011250 CCA-Claims Hiring for One Year Term This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time. Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements for Optum CES and Zelis edits. This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and research, as necessary on all new and revised coding logic, related Medicare/Medicaid policies for review/approval through the Payment Integrity governance process. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration requirements for Optum CES and Zelis edits. Quarterly and Annual review and research, as necessary on all new CPT and HCPCS codes for coding logic, related Medicare/Medicaid policies to make recommend reimbursement determinations. Analyze, measure, manage, and report outcome results on edits implemented. Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to industry standard coding regulations, and make recommendations based on new/revised coding edits for presentation to Payment Integrity committee meetings. Analyze, measure, manage, and report outcome results on edits implemented. Use and maintain the rules and policies specific to CES and Zelis. Query and analyze claims to address any negative editing impacts and create new opportunities for savings based on provider billing trends Liaison between business partners and vendors; bringing and interpreting business requests, providing solutioning options and documentation, developing new policies based on State and Federal requirements, host meetings, and managing projects to completion Define business requests received, narrow the scope of the request based on business needs and requirements, provider resolution option based on financial ability and forecasting for small to large Operations Management Collaborate system and data configuration into CES (Claims Editing System) with BPaaS vendor and other PI partners, perform user acceptance testing, and analyze post production reports for issues Support collaboration between PI/Claims and other internal stakeholders related to the identification and implementation of cost-savings initiatives specific to edits. Working Conditions: Standard office conditions. Remote opportunity. Other: Standard office equipment None/stationary Required Education (must have): Bachelor's Degree or Equivalent experience Ideal Candidate to have the one or all of the required certification OR willing to get certified within 1 year of employment - Certified Professional Coder (CPC) Certified Inpatient Coder (CIC) Certified Professional Medical Auditor (CPMA) Desired Education (nice to have): Masters Degree Required Experience (must have): 7+ years of Healthcare experience, specific to Medicare and Medicaid 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required 7+ years experience with Optum Claims Editing System (CES), Zelis, Lyric or other editing tools Extensive knowledge and experience in Healthcare Revenue Integrity, Payment Integrity, and Analytics 5+ years of Facets Claims Processing System Required Knowledge, Skills & Abilities (must have): Knowledge and experience of claim operations, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare) Medical Coding, Compliance, Payment Integrity and Analytics Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies (i.e . Center for Medicare & Medicaid Services (CMS) & MA Medicaid, Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) both practitioner and facility, modifier to procedure validation, and other CMS and American Medical Association (AMA) guidelines, etc.) Advanced experience of medical terminology and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims' processing policies, coding principals and payment methodologies Ability to work cross functionally to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives Ability to plan, organize, and manage own work; set priorities and measure performance against established benchmarks Ability to communicate and work effectively at multiple levels within the company Customer service orientation; positive outlook, self-motivated and able to motivate others Strong work ethic; able to solve problems and overcome challenges Required Language (must have): English Compensation Range/Target: $64,000 - $96,000 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.