Claim processor jobs in Roseville, CA

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Examiner - Workers Comp (Hybird Roseville, CA) PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80-85K. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types. Responsibilities Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report. Routes claims to appropriate Partnership departments and internal staff for additional review. Follows up and completes claims once response to request has been received. Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. Generates claims correspondence as needed. Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor. Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame. Supports Claims Department's needs for resolving all pended claim types. Participates in special projects and assignments as required. Identifies and reports trends of pending claims that are increasing or processes that appear dated. Recognizes and gives feedback to management on procedure changes that would result in more efficient operations. Other duties as assigned. Qualifications Education and Experience High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment. Special Skills, Licenses and Certifications Effective written and oral communication skills. Good organization skills. Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred. Performance Based Competencies Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines. Consistently meets production standards without compromising quality on all tasks. Work Environment And Physical Demands Ability to use a microcomputer keyboard. More than 95% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $30.38 - $36.46 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Full-time Description Summary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties. Essential Duties and Responsibilities include the following. Other duties may be assigned. · Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim. · Comprehensive understanding of employee benefits for medical, dental and vision plans. · Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims · Ensures all claims are coded properly. · Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability. · Maintains high quality standards to avoid paying claim incorrectly. · Maintains productivity standards set by Management. · Refers most questionable claims for investigation to claim examiner II for review and processing. · Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned. · Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt. · Performs other duties and responsibilities as assigned by Management. Supervisory Responsibilities: This job has no supervisory responsibilities. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Requirements Knowledge, Skills, & Abilities: Excellent written and verbal communication skills. Strong analytical skills and problem-solving skills. Must be dependable and maintain excellent attendance and punctuality Must be able to perform data entry operations quickly and accurately. Ability to grow with changing demands of the position and the company. Strong computer skills, including Word, Excel, and Outlook. Successful candidates must have experience processing medical claims for an insurance company or third party administrator Must be highly proficient in ICD-10, CPT, and HCPCS codes. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; Must have 3-5 years employee benefits industry/processing claims experience or equivalent combination of education and experience. Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations. Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record. Salary Description $21.00 - $26.00 DOE

Who is Federated Insurance? At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own. Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values. What Will You Do? Customer-focused, source of knowledge and comfort, desire to help, professional, self-motivated - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss. No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients. This is an in-office position that will work out of our Rancho Cordova, CA office, located at 10850 Gold Center Drive. A work from home option is not available. Responsibilities * Work with policyholders, attorneys, and others to ensure claims are resolved in a prompt, fair and courteous way. * Explain policy coverage to policyholders and third parties. * Complete thorough investigations and document facts relating to claims. * Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars. Minimum Qualifications * Current pursuing, or have obtained a four-year degree * Experience in a customer service role in industries such as retail, hospitality, logistics, banking, equipment dealerships, equipment rental, sales or similar fields * Ability to make confident decisions based on available information * Strong analytical, computer, and time management skills * Excellent written and verbal communication skills * Leadership experience is a plus Salary Range: $61,700 - $75,400 Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. In addition, this position is eligible for a Geographic Differential Payment. Details of this benefits will be discussed in the interview process.) What We Offer We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You. Employment Practices All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization. If California Resident, please review Federated's enhanced Privacy Policy.

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Handles day-to-day oversight of general, professional, and other liability claims in accordance with Adventist Health's claims program policies and procedures and within an assigned region or scope of responsibility. Maintains up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software, coordinating with market leadership, risk managers, defense counsel, and others. Receives assignments in the form of strategic objectives and is responsible for determining the appropriate tactical approach, resource allocation, scheduling, and goal setting to achieve desired outcomes. Collaborates with a high level of communication and customer service. Job Requirements: Education and Work Experience: * Bachelor's Degree in risk management, legal studies, nursing, or closely related field or equivalent combination of education/related experience: Required * Master's Degree: Preferred * Three years' related experience managing professional and general liability claims within a hospital system, insurance carrier, self-insured environment, law firm setting, or a combination of these: Preferred Licenses/Certifications: * Associate in Claims: Preferred * Chartered Property Casualty Underwriter: Preferred Essential Functions: * Manages a portfolio of claims from first notice through resolution. Coordinates litigation activity, including working closely with defense counsel, attending mediations, and contributing to legal strategy and trial preparation. Reviews attorney invoices and monitors counsel for compliance within organization policies and guidelines. Reviews and analyzes medical records, interviewes witnesses, assists with the discovery process and communicates with facility risk manager regarding evaluation and investigation. * Establishes and adjusts reserves based within organizational authority level. Develops and implements effective settlement strategies, engaging structured settlement professionals when appropriate. Identifies opportunities for subrogation, contribution, and recovery to reduce total claim costs and enhance overall case outcomes. Selects appropriate medical experts for case review. * Coordinates initial notice to reinsurers and provides timely updates on case status. Maintains accurate and detailed claim files in the claims management system, ensuring documentation of activity, decisions, and communications. Provides direction to support staff. * Notifies manager of identified trends or patterns in claims that may indicate systemic risk or opportunities for clinical improvement. Prepares claim summaries, reports, and dashboards for management and participates in claims review meetings. Develops and documents for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means. * Maintains the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the claims policies and procedures manual. Provides feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate system risk management issues. * Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit ******************************************** for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Handles day-to-day oversight of general, professional, and other liability claims in accordance with Adventist Health's claims program policies and procedures and within an assigned region or scope of responsibility. Maintains up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software, coordinating with market leadership, risk managers, defense counsel, and others. Receives assignments in the form of strategic objectives and is responsible for determining the appropriate tactical approach, resource allocation, scheduling, and goal setting to achieve desired outcomes. Collaborates with a high level of communication and customer service. Job Requirements: Education and Work Experience: * Bachelor's Degree in risk management, legal studies, nursing, or closely related field or equivalent combination of education/related experience: Required * Master's Degree: Preferred * Three years' related experience managing professional and general liability claims within a hospital system, insurance carrier, self-insured environment, law firm setting, or a combination of these: Preferred Licenses/Certifications: * Associate in Claims: Preferred * Chartered Property Casualty Underwriter: Preferred Essential Functions: * Manages a portfolio of claims from first notice through resolution. Coordinates litigation activity, including working closely with defense counsel, attending mediations, and contributing to legal strategy and trial preparation. Reviews attorney invoices and monitors counsel for compliance within organization policies and guidelines. Reviews and analyzes medical records, interviewes witnesses, assists with the discovery process and communicates with facility risk manager regarding evaluation and investigation. * Establishes and adjusts reserves based within organizational authority level. Develops and implements effective settlement strategies, engaging structured settlement professionals when appropriate. Identifies opportunities for subrogation, contribution, and recovery to reduce total claim costs and enhance overall case outcomes. Selects appropriate medical experts for case review. * Coordinates initial notice to reinsurers and provides timely updates on case status. Maintains accurate and detailed claim files in the claims management system, ensuring documentation of activity, decisions, and communications. Provides direction to support staff. * Notifies manager of identified trends or patterns in claims that may indicate systemic risk or opportunities for clinical improvement. Prepares claim summaries, reports, and dashboards for management and participates in claims review meetings. Develops and documents for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means. * Maintains the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the claims policies and procedures manual. Provides feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate system risk management issues. * Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit ******************************************** for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB This Claims Specialist is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards. The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a California complex claims inventory. Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: Consistently provides exceptional customer service. Effectively collaborates with team members from various departments for project and process discussions. Acts as a Subject Matter Expert for the department. Makes recommendations for streamlining processes and adopting the industry's best practices. Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. Provides knowledge transfer across the organization. Continuously seeks to improve technical skills by attending job related training and tracking current case law. Acts as a mentor and provides training for less experienced team members. Prepares and presents claims status reports for internal and external stakeholders. Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 8-10 years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Thorough understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information to management, public groups, and/or boards of directors. Must be adept at learning new technology and embrace change. Facilitates and leads meetings across a team of claims professionals for assigned projects. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $78,678.61 - $132,686.15 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? • Challenging work and the ability to make a difference • You will have a voice and feel a sense of belonging • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match • Bonus potential for all positions • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) • 11 paid holidays throughout the calendar year • Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Supervisor II - Commercial Auto - BI to join our team. Summary: Supervises claims adjusters and technical support staff to manage the day-to-day handling and settlement of claims, the processing and tracking of documents, making payments, tracking trends and communicating with underwriting. A typical day will include the following: Supervises the day-to-day activities of a claims handling unit; oversees the investigation of insurance claims. Assures that corporate claims handling procedures and priorities are followed and that budget and productivity requirements are met. Assures that department targets for customer service quality and priorities are met. Participates in the hiring, training, evaluation and development of the claims staff. Qualifications: High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. Associate in Claims, CPCU or other industry related studies. Experience with Windows operating system. Basic Word processing skills. National Range : $112,165.00 - $125,360.00 Ultimate salary offered will be based on factors such as applicant experience and geographic location. PHLY locations considered: Roseville, CA / Seattle, WA / West Linn, OR. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 2 **What Is the Opportunity?** Travelers' Claim Organization is at the heart of our business. By providing assurance to our customers during life's rainy days, the Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As a Workers Compensation Claim Professional Trainee, you will handle all aspects of a workers compensation claims. In this role, you will learn how to help our customers and their injured employees when they are injured at work. You will develop the technical skills needed for quality claim handling including investigating, evaluating, negotiating, and resolving claims on losses of lesser value and complexity and provide claim handling throughout the claim life cycle. As part of the hiring process, this position will require 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. **What Will You Do?** + Complete virtual, classroom, and on-the-job training which includes the overall instruction, exposure, and preparation for employees. Completion of an internal training program is required to progress to next level position. The training may require travel. + Handle all aspects of a Workers Compensation claim including completing investigations, setting accurate reserves, and making various claim-related decisions under direct supervision. As a trainee, you may also be exposed to claims that could involve litigation, settlement negotiations, Medicare set asides and offsets. + Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. + Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. + Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources. + Effectively prioritize and manage a Workers Compensation claim inventory, including filing and diary systems, document plans of action and complete time-sensitive required letters and state forms. + Participate in Telephonic and/or onsite File Reviews. + Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree or a minimum of 2 years of work or customer service-related experience. + Ability to work in a high volume, fast paced environment managing multiple priorities while facing ambiguity. + Able to review information from multiple sources and use analytical thinking and problem-solving skills to accurately achieve optimal claim outcomes and determine appropriate next steps. + Ability to own and manage all assigned tasks. + Provide excellent customer experience by communicating effectively, verbally and written. + Able to work independently and in a team environment. + Strong attention to detail. **What is a Must Have?** + High School Diploma or GED + One year of customer service experience OR Bachelor's Degree. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

Job Details 7311 GREENHAVEN DRIVE 145 - SACRAMENTO, CA Full Time $73000.00 - $90000.00 Salary None Day Admin - ClericalDescription The Claims Supervisor is responsible for claims processing, knowledge of healthcare regulatory guidelines, computer system functionality, the ability to multi-task, coordinate with customers like health plans and provide accurate data through extensive research skills. This position requires some leadership skills and an ability to provide detailed orientated instructions to staff while assisting them in maintaining and coordinating their daily operational duties. Responsibilities: Plans and assigns work; monitors department workload to ensure mandated turnaround times are met; makes timely and effective adjustments daily, weekly, and monthly. Identifies, monitors and analyzes appropriate metrics, including production, inventory and submission/billing patterns; develops timely and effective corrective action plans based on findings. Track the inventory prior to check run process by coordinating with the staff to make sure that the process is finalized. Oversee provider dispute resolution processes and resolve PDRs as necessary. Oversee recovery processes and resolve overpayments as necessary. Responds to and resolves or facilitates resolution of complex claims, appeals, provider disputes, and recovery projects. Coordinate with all interdepartmental units to improve workflow and processes; identifies issues and opportunities; initiates meetings; resolves issues or makes recommendations as required. Distribute work as necessary to the staff daily and weekly. Attend meetings on claims related matters that have direct and in-direct relationship to your positions providing an update to the claims management team. Attend Claims Operational meetings and participate in the dialogue to provide insight and assist in bringing resolution to open matters. Provide direction to staff in the area of claims timeliness guidelines, new rules from governing agencies (CMS & DMHC), and overall claims background. Manage the department in meeting and maintaining all Regulatory and Health Care Industry standards. Coordinate with all claims staff to ensure that they are collectively networking as a team on all claims matters within the department. Identifies training needs and opportunities; develops training plans. Assists in the development of departmental goals and tasks to achieve goals. Hires, supervises and retains competent staff. Writes and delivers performance evaluations and goals to claim staff. Regular attendance. Travel as required. Other Functions Enforces Company policies and safety procedures. Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations. Maintain IPA, Health Plan compliance standards. Qualifications Competencies Five (5) years healthcare claims experience, which includes all aspects of claims administration. Two (2) years Medi-Cal claims experience. Two (2) years supervisory experience. Managed care experience preferred. In-depth knowledge of regulations and procedures governing Medi-Cal and other state sponsored programs required. In-depth knowledge of procedure coding and medical terminology, and their application in benefits; general medical policy benefits and exclusions, and industry standard payment practices required. Ability to read, interpret and apply complex written guidelines, instructions and other materials. In-depth knowledge of claims processing systems. In-depth knowledge of audit processes, and the ability to effectively implement and maintain them. Demonstrate ability to articulate and embrace organizational values, integrate into management practices, and enforce implementation among staff. Intermediate skills in Word and Excel, including the ability to develop formulas and links. Excellent communication skills, including both oral and written. Excellent active listening and critical thinking skills. Ability to solve advanced level problems with minimal supervision. Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers. Ability to multi-task, exercise excellent time management, and meet multiple deadlines. Demonstrate excellence in project management and organization. Strong computer skills, including experience with Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel) Ability to provide and receive constructive job and/or industry related feedback. Ability to maintain confidentiality and appropriately share information on a need to know basis. Ability to consistently deliver excellent customer service. Excellent attention to detail and ability to document information accurately. Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives. Ability to demonstrate professionalism, confidence, and sincerity in a diverse work culture. Demonstrate commitment to the organization's mission. Must have the ability to quickly learn and use new software tools. Must have mid-level skills using e-mail applications. Ability to work independently as well as in a team environment. Ability to present self in a professional manner and represent the Company image. Demonstrate leadership and project success are expected. Education and Licensure High School Diploma or GED minimum requirement. BA/BS in Business Management or related field preferred. Travel The incumbent may travel up to 5% of the time. Supervisor Responsibility This position supervises several employees in multiple disciplines: Claims Analysts, Claim Specialist, Eligibility Specialists, and/or Claim Auditors. Up to 12 non-exempt employees. Work Environment This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets. Mental and Physical Demands Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing this job, the employee is regularly required to talk and hear. The employee frequently is required to sit, stand; walk; use hands to finger, handle, or feel; and reach with hand and arms. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. Experiences frequent interruptions; required to meet inflexible deadlines; requires concentration and attention to detail; requires a high level of organizational and prioritization skills. May be required to sit for prolonged periods; exposed to visual display terminal for prolonged periods; dexterity and precision required in the operation of a computer.

Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service. Key Responsibilities Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures. Review and interpret policy language to determine coverage and consult with coverage counsel when needed. Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies. Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information. Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts. Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards. Participate in file reviews, team meetings, and ongoing training to support continuous learning. Salary Range $95,000.00-$145,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Qualifications Minimum of 3 years of trucking industry experience. Experience with bodily injury and/or cargo exposures. Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices. Strong analytical and negotiation skills, with the ability to manage multiple priorities. Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism. Possession of applicable state adjuster licenses. Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.

We are recruiting for multiple Claims Analysts to support a busy healthcare department at their corporate office in Sacramento. This is a contract (6 months) opportunity with potential for hire based on performance and business needs. Our client is a progressive organization that specializes in connecting people with support resources and access to healthcare. The Claims Analyst will be responsible for the accurate and timely processing of CMS-1500 and CMS-1450 (UB-04) claims forms, adjustments to previously processed claims and completing denied claims due to eligibility and coding. The qualified candidate will have at least one year of experience with Medicare and Medi-Cal claims processing and adjudication. Pay: $23/hour Schedule: Mon-Fri, onsite (hybrid opportunity after training and probationary period). PRIMARY RESPONSIBILITIES: Review and process medical claims in accordance with company policies and procedures. Determine coverage, complete eligibility verifications, and identify discrepancies. Review claims or referral submissions to determine, review, or apply appropriate guidelines, member identification processes, provider selection, and claim coding, including procedure, diagnosis, and pre-coding requirements. Check for erroneous items or codes, missing information and make corrections according to policies and procedures. Maintain claims production standard and consistently meet quality standards. Receive, sort, and organize incoming claims for scanning. Update and correct denied claims. Prepare and mail out daily claims correspondence. Research, update and/or correct member eligibility. SKILLS & QUALIFICATIONS: 1 year of Medicare and or/Medi-Cal claims processing experience required. 1 years in managed care claims processing and claims adjudication desired. High School Diploma required, Associate's degree preferred. Medicare HMO/IPA experience preferred. Familiarity with ICD-10, HCPCS, CPT coding, modifiers, DMHC regulations, facility, and professional claim billing practices. Ability to maintain quality goals in a production driven environment. Ability to follow through on commitments and meet deadlines. Excellent communication skills, including both verbal and written. Ability to pass a drug screen and background check.

Worker Compensation Claims Adjuster Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Rocklin We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations. Our Mission: To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives. Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes. Our Goal: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients. Your Impact: Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance Ensure all claims are handled in accordance with relevant statutes and company guidelines Address personnel issues promptly and decisively, keeping management informed of corrective action Foster a collaborative and productive team environment focused on excellence in claim resolution Our Offer: Competitive salary and benefits package, including medical, dental, vision, and 401(k) Opportunity for professional growth and advancement in a dynamic organization Collaborative work environment with a team dedicated to workers' compensation excellence Interested? Get in Touch: To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following: Apply to this posting Call me directly at ************ Email [email protected] We look forward to hearing from you! “Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.”

As an FCA Examiner, you will: Serve as examiner-in-charge (EIC) of institutions, including large, complex, or high-risk institutions. Develop and finalize the examination scope, approach, and allocation of Agency resources for identifying institutional risks, assessing safety and soundness, and determining corrective actions. Establish proactive risk-based ongoing oversight programs to monitor emerging issues and assess impact on Financial Institution Rating System (FIRS) ratings. Prepare written communications on issues of increased complexity, conveying oversight and examination results as well as matters requiring attention to institution boards of directors and management teams. Develop, lead, and maintain ongoing communications with assigned institutions to timely exchange information, identify emerging risks and issues, and discuss oversight/examination findings and conclusions. Develop and manage a program of ongoing oversight and examination activities to assess asset quality, financial condition, management capabilities, internal controls, general operations, and compliance with laws and regulations as well as sound business practices. Requirements Conditions of Employment Must be a U.S. citizen. One year probationary period, unless previously served. One year supervisory or managerial probationary period, unless previously served. Suitability for Federal employment, as determined by a background investigation. Submission of a financial disclosure report may be required. Males born after 12-31-59 must be registered for Selective Service. Complete the initial online assessment and USAHire Assessment, if required Qualifications You may qualify at the VH-38 (GS-12) band level if you have one year of specialized experience equivalent to the VH-37 (GS-11) band level in the Federal service that demonstrates your ability to examine or audit financial institutions for adherence to regulatory policy related to capital markets, credit risk, information technology risks and/or consumer compliance. You may qualify at the VH-39 (GS-13) band level if you have one year of specialized experience equivalent to the VH-38 (GS-12) band in the Federal service that demonstrates your ability to examine or audit financial institutions for adherence to regulatory policy related to capital markets, credit risk, information technology risks and/or consumer compliance; or experience in the credit or lending operations (e.g., serving as a lending officer or credit decision maker) at a financial institution. Proof of Commissioned examiner status or equivalent required. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Education You may not substitute education for experience at the VH-38 or VH-39 band level.

Under the direction of the Corporation Examiner IV (Supervisor), Division of Financial Oversight, the Corporation Examiner will perform field examinations of the financial and administrative affairs of full service and specialized health care service plans (i.e., HMOs, dental, vision, behavioral and chiropractic). DMHC's Division of Financial Oversight is responsible for protecting Californians who receive services from licensed health care service plans and their provider networks by ensuring they are fiscally viable and comply with the financial provisions of the Knox-Keene Act and related rules. This mission is accomplished through the performance of onsite regulatory examinations, analysis of regulatory filings and requiring necessary corrective actions in coordination with other disciplines in the DMHC. Occassional travel for audits/examinations upon request. Please let us know how you heard about this position by taking a brief survey: DMHC Recruitment Survey. Leave Program (PLP) 2025 agreement: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position's associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. You will find additional information about the job in the Duty Statement. Working Conditions The DMHC has locations in Downtown Sacramento and Rancho Cordova. Both locations are located close to light-rail with various amenities. The incumbent will work in a climate-controlled cubicle and/or office environment with artificial lighting. This position may be eligible for hybrid telework. The telework schedule is permitted at the operational needs of the Department and is subject to change, consistent with the State Telework Policy and the DMHC's Telework Policy. All employees who telework are required to be California residents and maintain California residency in accordance with Government Code 14200. Minimum Requirements You will find the Minimum Requirements in the Class Specification. * CORPORATION EXAMINER * AUDITOR I Additional Documents * Job Application Package Checklist * Duty Statement Position Details Job Code #: JC-500164 Position #(s): 409-123-4443-059 Working Title: Examiner Classification: CORPORATION EXAMINER $6,056.00 - $7,586.00 A $7,301.00 - $9,143.00 B New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable. Shall Consider: AUDITOR I $4,256.00 - $5,600.00 # of Positions: 1 Work Location: Sacramento County Telework: Hybrid Job Type: Permanent, Full Time Department Information The mission of the Department of Managed Health Care (DMHC) is to is to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system. The DMHC accomplishes its mission by ensuring the health care system works for consumers. The Department protects the health care rights of 30.2 million Californians by regulating health care service plans, assisting consumers through a consumer Help Center, educating consumers on their rights and responsibilities and preserving the financial stability of the managed health care system. DMHC values diversity at all levels of the organization and is committed to fostering an environment in which employees from a variety of backgrounds, cultures, and personal experiences are welcomed and can thrive. DMHC believes the diversity of our employees and their unique ideas inspire innovative solutions to further our mission. Join DMHC and help us improve the lives of all Californians. If you are interested in learning about the Department of Managed Health Care (DMHC) culture from the perspective of someone like yourself, contact our Someone Like Me program (please check your Spam or Junk folders for our email replies). Within five business days of your request to participate in the Someone Like Me program, you will be matched with a DMHC employee with a similar background to discuss the DMHC's culture. This program is not part of, or in any way affiliated with the application or hiring process. Prospective employees must complete the application process on Cal Careers (e.g., submit your application within the specified timeframes on the job posting) to be considered for hire at the DMHC. None of the information you provide through the Someone Like Me program will be relayed to the Hiring Unit. Department Website: ********************** Special Requirements * The position(s) require(s) a Background Investigation be cleared prior to being hired. All applicants not currently employed by the DMHC will be subject to a pre-employment background investigation. The investigation will consist of fingerprinting and an inquiry to the California Department of Justice to disclose criminal records. Any documents you submit for a job vacancy such as your State application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents include, but is not limited to, your Social Security Number (SSN), birthday, driver's license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver's license number will automatically be redacted upon submission. Possession of Minimum Qualifications will be verified prior to interview and/or appointment. If you are using education to meet the minimum qualifications for this position, you MUST submit a copy of your college transcripts. Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment. Application Instructions Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application. Final Filing Date: 12/25/2025 Who May Apply Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply. Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s). How To Apply Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at ********************** When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below: Address for Mailing Application Packages You may submit your application and any applicable or required documents to: Department of Managed Health Care DMHC Recruitment Attn: Human Resource Office 980 9th Street, Suite 500 Sacramento, CA 95814 Address for Drop-Off Application Packages You may drop off your application and any applicable or required documents at: Department of Managed Health Care DMHC Recruitment Human Resource Office 980 9th Street, Suite 500 Sacramento, CA 95814 08:00 AM - 05:00 PM Required Application Package Documents The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job: * Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at ********************** All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position. * Resume is required and must be included. Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting. Desirable Qualifications In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate: 1. Knowledge and ability to apply Generally Accepted Accounting Principles, Generally Accepted Auditing Standards, Audit and Accounting Guide for Health Care Organizations (AICPA), and other accounting or auditing standards. 2. Excellent written communication skills to produce professional work papers and reports. 3. Excellent oral communication skills to communicate effectively and tactfully with internal and external stakeholders. 4. Excellent organizational skills and logical reasoning to reach sound conclusions and produce a quality work product. 5. Prefer college degree with a major in Accounting including college level courses in accounting, auditing, business administration, public administration, business law, and/or corporate finance. 6. Experience gathering, organizing and interpreting financial data to prepare reports and/or recommendations. 7. Experience with Microsoft Access, Excel, Word and/or Audit Command Language (ACL). 8. Experience with examination protocols including the usage of workbooks or reference materials. 9. Experience or education evaluating financial statements. 10. Experience conducting examinations (financial and/or claims). 11. Motivated to learn and produce a quality work product. 12. CPA, CPA Candidate or in the process of taking the CPA examination are preferred, but not required. 13. Ability to travel within California up to 25% of the work time for examinations and/or training. May occasionally require out-of-state travel. 14. Understanding of federal and state legislation, statutes and regulations related to health care. 15. Ability to be flexible in response to a changing workload. 16. Ability to demonstrate a positive attitude and work cooperatively and effectively with others. Benefits Benefit information can be found on the CalHR website and the CalPERS website. Contact Information The Human Resources Contact is available to answer questions regarding the application process. The Hiring Unit Contact is available to answer questions regarding the position. Department Website: ********************** Human Resources Contact: DMHC Recruitment ************** *********************** Hiring Unit Contact: Suhag Patel ************** *********************** Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office. EEO Contact: EEO Office ************** *************** California Relay Service: ************** (TTY), ************** (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device. Additional Application Instructions To be considered for this vacancy, please complete all applicable fields on the application form, including a list or description of previous/current occupational experience in the duties performed section. Electronic applications through your CalCareer account are highly recommended. If you are unable to apply electronically through your CalCareer account, please mail or drop off a hard copy of your application packet. Please notate RPA: 25-128 and Job Control: JC-500164 on your application. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to clearly demonstrate how you meet the Minimum Qualifications for the position on your State Application (STD Form 678). The application should also clearly demonstrate the candidate's ability to meet the Desirable Qualifications identified in this job advertisement. The Classification Specification for Corporation Examiner will consider Auditor I is located at the top of this Job Announcement Posting under Minimum Requirements. Foreign Degrees or Transcripts - Applicants with foreign degrees or transcripts who wish to apply that coursework toward meeting the minimum qualifications of the classification must provide a transcript evaluation that indicates the number of units to which his/her foreign coursework is equivalent. DMHC accepts foreign transcript evaluations that are completed by one of the agencies approved by the California Commission on Teacher Credentialing. PLEASE NOTE: If you are mailing your application, it must be postmarked by the final filing date. Hand delivered applications must be submitted no later than 5:00 p.m. on the final filing date. Applications slipped under the door at the Human Resources Office will be time stamped the following business day. Equal Opportunity Employer The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation. It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.

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 an acknowledged technical expert and be responsible for the resolution of high complexity and high exposure Public Company D&O and Financial Institutions D&O and E&O claims. The position will have significant responsibility for decision making and work autonomously within their authority. Job Duties: * Confirms coverage of claims by reviewing policies and documents submitted in support of claims * Analyzes coverage and communicates coverage positions * Conducts, coordinates, and directs investigation into loss facts and extent of damages * Directs and monitors assignments to experts and outside counsel * Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure * Sets timely reserves within authority or makes claim recommendations concerning reserve changes to supervisor * Negotiates and settles claims either directly or indirectly * Prepares reports by collecting and summarizing information * Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives * Assists in training and mentoring of examiners * Serves as technical resource to subordinates and others in the organization. * Reviews and approves correspondence,s reports and authority requests as directed by supervisor * Participates in special projects or assists other team members as requested * Travel to meditations, trials, and conferences as required Education * Bachelor's degree or equivalent work experience * JD , advanced degree, or focused technical degree a plus Certification * Must have or be eligible to receive claims adjuster license. * Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU, RPLU) or * I-Lead or other Management Training Work Experience * Public Company D&O, Financial Institutions D&O and E&O, Financial Advisors, and/or Management Liability Claims handling experience preferred. * Minimum of 10 years of claims handling experience or equivalent combination of education and experience Skill Sets * Excellent written and oral communication skills * Strong analytical and problem solving skills * Strong organization and time management skills * Ability to deliver outstanding customer service * Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word) * Ability to work in a team environment * Strong desire for continuous improvement 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 national average salary for the Executive Claims Specialist - Executive Liability is $97,520 - $134,090 with 25% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

Milliken & Company is a global manufacturing leader whose focus on materials science delivers tomorrow's breakthroughs today. From industry-leading molecules to sustainable innovations, Milliken creates products that enhance people's lives and deliver solutions for its customers and communities. Drawing on thousands of patents and a portfolio with applications across the textile, flooring, chemical and healthcare businesses, the company harnesses a shared sense of integrity and excellence to positively impact the world for generations. Discover more about Milliken's curious minds and inspired solutions at Milliken.com and on Facebook, Instagram and LinkedIn. Job Title: Customer Claims Coordinator Job Summary: This position reports to the Claims Manager and is responsible for handling claims, resolving claims and deals with customers and the sales force. The position is directed to create customer satisfaction and drive defect elimination when processing customer concerns, while processing claims in a timely manner, must identify the root cause of the claim and drive to the appropriate resolution including the issuance of credit memos and/or decline to the customer. The work schedule is Monday - Friday, 8:00 am - 5:00 pm. Key Responsibilities: Receive claim calls from customers or Milliken sales Document all claim communications Research and attach claim details from Milliken systems Prepare and transmit outgoing communication to customers and sales organization Receive, investigate and reconcile customers deductions Issue credit memos according established guidelines Qualifications - Preferred High school diploma or equivalent Good phone etiquette Basic math skills Good written and verbal communication sills Knowledge of SAP The successful candidate should demonstrate strengths in the following: Problem solving and analytical skills Initiative and self-motivation Communications skills Good computer skills Excellent typing skills Milliken is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to actual or perceived race, color, creed, religion, sex or gender (including pregnancy, childbirth or related medical condition, including but not limited to lactation), sexual orientation, gender identity or gender expression (including transgender status), ancestry, national origin, citizenship, age physical or mental disability, genetic information, marital status, veteran or military status or any other characteristic protected by applicable law. To request a reasonable accommodation to complete a job application, pre-employment testing, a job interview, or to otherwise participate in the hiring process, please contact ******************************.

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $94,400.00 - $155,800.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign-on bonus of up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. What Will You Do? * Directly handles assigned severity claims. * Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Consults with Manager on use of Claim Coverage Counsel as needed. * Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. * Maintains claim files and documents claim file activities in accordance with established procedures. * Utilizes evaluation documentation tools in accordance with department guidelines. * Proactively creates Claim File Analysis (CFA) by adhering to quality standards. * Utilizes diary management system to ensure that all claims are handled timely. * At required time intervals, evaluate liability & damages exposure. * Establishes and maintains proper indemnity and expense reserves. * Recommends appropriate cases for discussion at roundtable. * Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. * Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. * Develops and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiates disposition of claims with insureds and claimants or their legal representatives. * Recognizes and implements alternate means of resolution. * Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, * Tracks and controls legal expenses to assure cost-effective resolution. * Effectively and efficiently manage both allocated and unallocated loss adjustment expenses. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * 5 years equivalent business experience. * Advanced level knowledge and skill in claim and litigation. * Basic working level knowledge and skill in various business line products. * Strong negotiation and customer service skills. * Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices. * Demonstrated coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced. * Judgment/Decision Making - Advanced. * Communication - Advanced. * Negotiation - Advanced. * Insurance Contract. * Knowledge - Advanced. * Principles of Investigation - Advanced. * Value Determination - Advanced. * Settlement Techniques - Advanced. * Legal Knowledge - Advanced. * Medical Knowledge - Intermediate. What is a Must Have? * High School Degree or GED. * 3 years of liability claim handling experience and/or comparable litigation claim experience. * In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. * Generally, license(s) are required to be obtained within three months of starting the job. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Job DescriptionWorker Compensation Claims Adjuster Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Rocklin We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations. Our Mission: To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives. Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes. Our Goal: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients. Your Impact: Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance Ensure all claims are handled in accordance with relevant statutes and company guidelines Address personnel issues promptly and decisively, keeping management informed of corrective action Foster a collaborative and productive team environment focused on excellence in claim resolution Our Offer: Competitive salary and benefits package, including medical, dental, vision, and 401(k) Opportunity for professional growth and advancement in a dynamic organization Collaborative work environment with a team dedicated to workers' compensation excellence Interested? Get in Touch: To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following: Apply to this posting Call me directly at ************ Email ************************ We look forward to hearing from you! “Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.” Powered by JazzHR EGyi48bHSa