Claim processor jobs in Sacramento, CA - 74 jobs

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

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.

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: $63,800 - $78,000 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.

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

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

To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers. Responsibilities Supervises the Medi-Cal claims specialists and examining staff. Daily supervision of the claims workflow. Supports claim examining and specialist functions. Maintains claim inventories within established goals. Interviews and participates in the selection of qualified candidates for the Medi-Cal claims specialist and examining positions. Evaluates performance and provides developmental opportunities to staff. Provides training of new staff as appropriate. Counsels performance problems or issues when needed. Reviews and signs time cards. Reviews quality control audits with staff to ensure compliance within established department guidelines, policies and procedures. Identifies errors and deficiencies; develops and implements corrective action and training plans for staff. Reviews department policies and procedures, recommends changes for more efficient operations, communicates changes and updates to staff when appropriate. Monitors and maintains pended claims within established department guidelines. Reviews and researches reasons for the lags related to pended claims. Reviews and maintains Batch Error reports within established department guidelines. Reviews Medi-Cal RAs weekly. Prepares production statistics and related reports for the Manager's/Director's review. Reviews and signs claim adjustments and high dollar claims within established guidelines. Other duties as assigned. Qualifications Education and Experience Bachelor's degree in related field preferred; minimum three (3) years supervisor experience in a claims environment; or equivalent combination of education and experience; prior Medi-Cal claims experience preferred. Special Skills, Licenses and Certifications Thorough knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding. Knowledge of medical terminology. Expertise in automated claims procedures and related problems resolution. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver's license and proof of current automobile insurance compliant with Partnershp policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and supervise staff to effectively complete assignments within established time frames and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills. Work Environment And Physical Demands Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 10 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: $45.04 - $56.30 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.

If you're passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors. The Property Claims Field Adjuster will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle minor to moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers. The territory supported by this role is South Orange County, CA, specifically covering areas like Lake Forest, Ladera Ranch, and surrounding communities. An in-person interview may be required during the hiring process. Geo-Salary Information State specific pay scales for this role are as follows: $61,864 to $108,197 (CA, NJ, NY, WA, HI, AK, MD, CT, RI, MA) The expected base salary for this position will vary depending on a number of factors, including relevant experience, skills and location. Responsibilities Essential Job Functions: • Investigate and resolve Homeowners claims of minor to moderate complexity in a timely and efficient manner. Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes. • Ability to perform field inspections at least 50% of work time. (company car provided) This will involve travelling to our customers' home to conduct on-site inspections, thoroughly investigate coverage and prepare detailed estimate to efficiently resolve their claims. • Ability to handle virtual claims. Must have ability to use imagery, and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting when needed. • Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate. • Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval. • Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction. This includes timely response to phone calls, emails, texts, written communication, and adherence to Department of Insurance requirements. • Prioritizes own responsibilities and effectively manages claims workload to regularly monitor progress and expenses to properly resolve inventory to conclusion. • At times may direct, monitor, and review files handled by independent adjusters to conclusion. • Other functions may be assigned Qualifications Education: • Bachelor's degree preferred or equivalent combination of education and experience. • Valid driver's license is required. • Ability to obtain state specific property claims licensing, as required. • Must successfully participate and complete formal property claims training program that may take place in person, virtually, or a combination of both. Experience: • Have prior experience using estimating software like Xactimate. • Experience in a related field: property claims experience, customer service environment, construction, restoration, mitigation • Are known for clear and professional communication, both written and verbal • Are bilingual and/or have prior military experience is a plus • 1-3 years equivalent industry experience is preferred Knowledge and Skills: As a Property Claims Field Adjuster 1, you will: • Possess the ability to work independently with limited or no supervision over daily activities required to successfully investigate, evaluate, write damage estimates, negotiate, and resolve property claims • Have a passion for outstanding customer service • Make quality decisions based upon a mixture of analysis, wisdom, experience, and judgment, including the ability to negotiate. • Be comfortable with and adaptable to new technology and business tools • Be able to seamlessly transition between various methods of inspection, including physical, video, or photo, to write a damage estimate: o May include climbing ladders to inspect roofing or attic space and inspection of crawl spaces. o Ability to lift and carry up to 50 pounds. • Possess strong organizational, time management, and prioritization skills to handle varying workloads due to seasonal volume changes and catastrophes. • Be able and willing to work flexible work shifts and may be asked to work overtime, as needs arise. • Drive to and from multiple locations and occasionally outside of normal business hours. About the Company Why choose a career at Mercury? At Mercury, we have been guided by our purpose to help people reduce risk and overcome unexpected events for more than 60 years. We are one team with a common goal to help others. Everyone needs insurance and we can't imagine a world without it. Our team will encourage you to grow, make time to have fun, and work together to make great things happen. We embrace the strengths and values of each team member. We believe in having diverse perspectives where everyone is included, to serve customers from all walks of life. We care about our people, and we mean it. We reward our talented professionals with a competitive salary, bonus potential, and a variety of benefits to help our team members reach their health, retirement, and professional goals. Learn more about us here: ********************************************** Perks and Benefits We offer many great benefits, including: Competitive compensation Flexibility to work from anywhere in the United States for most positions Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours) Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus) Medical, dental, vision, life, and pet insurance 401 (k) retirement savings plan with company match Engaging work environment Promotional opportunities Education assistance Professional and personal development opportunities Company recognition program Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more Mercury Insurance is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by federal, state, or local law. Pay Range USD $61,864.00 - USD $108,197.00 /Yr.

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 CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$52,600.00 - $86,800.00Target Openings3What Is the Opportunity?Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. 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 an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. 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? Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision. 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. Participate in Telephonic and/or onsite File Reviews. Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts. Gather information from policyholders, claimants, witnesses, and third-party providers. Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. Maintain accurate records of claim activity in claim management systems. 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. Demonstrate openness to continuous learning, particularly in AI and digital transformation. 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? Previous internship or work experience in insurance, finance, or customer service. Strong attention to detail and organizational skills. Ability to manage multiple tasks and prioritize effectively. Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. Ability to exercise sound judgement and make effective decisions. Strong verbal and written communication skills with the ability to convey information clearly and professionally. 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 *********************************************************

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 *****************************************

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.

Contract 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.

**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** 3 **What Is the Opportunity?** Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. 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 an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. 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?** + Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. + Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision. + 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. + Participate in Telephonic and/or onsite File Reviews. + Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts. + Gather information from policyholders, claimants, witnesses, and third-party providers. + Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. + Maintain accurate records of claim activity in claim management systems. + 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. + Demonstrate openness to continuous learning, particularly in AI and digital transformation. + 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?** + Previous internship or work experience in insurance, finance, or customer service. + Strong attention to detail and organizational skills. + Ability to manage multiple tasks and prioritize effectively. + Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. + Ability to exercise sound judgement and make effective decisions. + Strong verbal and written communication skills with the ability to convey information clearly and professionally. **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 ******************************************************** .

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 general supervision of the Assistant Deputy Director, the Supervising Examiner is responsible for directing the provider solvency program within the Division of Provider Solvency. The provider solvency program is charged with overseeing the fiscal viability of medical groups and Independent Physician Associations that qualify as Risk-Bearing Organizations (RBOs), which includes financial solvency monitoring, review of all financial filings, addressing compliance issues, corrective action plans, and conducting financial and claims examinations. Occasional travel for meetings and/or conferences. 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. * SUPERVISING CORPORATION EXAMINER Additional Documents * Job Application Package Checklist * Duty Statement Position Details Job Code #: JC-503149 Position #(s): 409-131-4440-008 Working Title: Supervising Examiner Classification: SUPERVISING CORPORATION EXAMINER $10,551.00 - $12,578.00 New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable. # 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: 1/23/2026 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. Experience and knowledge with general and specialized accounting and auditing principles and procedures; laws, policies, rules and regulations administered by the Department of Managed Health Care. 2. Knowledge and ability to apply the Generally Accepted Auditing Standards (GAAS), Generally Accepted Accounting Principles (GAAP), Audit and Accounting Guide for Health Care Organizations (AICPA), Generally Accepted Governmental Auditing Standards (GAGAS), and other accounting or auditing standards. 3. Knowledge of the Knox-Keene Act for licensure applications; notices of material modifications and amendments to application file. 4. Ability to direct senior examiners and examiner staff to ensure staff is properly trained to perform essential job. 5. Experience in developing, implementing and supervising training programs to ensure staff is properly trained / educated. 6. Ability to administer procedures and program activities; gather, organize, summarize and interpret financial data; analyze situations accurately and adopt an effective course of action; prepare reports. 7. Establish and maintain cooperative relations with internal and external stakeholders. 8. Possess strong oral and written communication skills. 9. Experience developing, planning, and overseeing examinations of programs such as audits, program review, and budget reviews. 10. Knowledge and expertise with the principles and practices of public and business administration, including personnel management. 11. Experience with Microsoft Access, Excel, Word and/or Audit Command Language (ACL). 12. Experience reviewing financial statements, such as income statements, balance sheets and/or cash flow statements. 13. Experience in analyzing financial projections and assumptions in a Corrective Action Plan. 14. Experience gathering, organizing, summarizing and interpreting financial data to prepare reports and/or recommendations. 15. Experience with examination protocols including the usage of workbooks or reference materials. 16. Preferred college level education with courses in accounting, auditing, business administration, public administration, business law, and/or corporate finance with verifiable transcripts. 17. Possess CPA license or CPA Candidate in the process to take CPA test are preferred, but not required. 18. Understanding of federal and state legislation, statutes and regulations related to health care. 19. Strong written and oral communication skills. 20. Strong organizational skills and a commitment to producing a quality work product. 21. Ability to use tact and good judgment. 22. Ability to be flexible in response to changing workload. 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 position or application process. Department Website: ********************** Human Resources Contact: DMHC Recruitment ************** *********************** 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: 25-135 and Job Control: JC-503149 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 Supervising Corporation Examiner 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.

ABOUT THE ROLE The Claims Representative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The Claims Representative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards. You will need to be located within 35miles of either plant facility: Vacaville, CA or West Sacramento, CA Three days work from home and two days in office. WHAT YOU'LL DO Claim Intake & Validation Receive, review, and validate incoming warranty claims to determine accuracy and required information. Initiate clarification calls to customers as needed to complete claim details. Maintain accurate claim documentation and communication updates within Dynamics 365 CRM. Claim Management & Resolution Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality. Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction. Host product standards and compliance discussions with customers, helping address concerns professionally and clearly. Administer service reimbursements and prepare settlement letters when applicable. Quality Review & Root Cause Analysis Conduct research to identify root causes of product or service issues. Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements. Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality. Communication & Reporting Prepare clear communications and updates for management regarding claim trends, issues, and opportunities. Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete. Perform additional duties as assigned to support departmental needs. SKILLS & QUALIFICATIONS Strong ability to interpret customer claims and apply relevant warranty coverage. Ability to read and interpret product specifications, drawings, and order confirmations. Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions. Strong verbal and written communication skills with a customer-centric approach. Ability to manage difficult discussions and mitigate customer dissatisfaction effectively. Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly. Strong attention to detail and accuracy in a fast-paced environment. Ability to work independently while supporting team and departmental goals. High curiosity, initiative, and willingness to grow in an evolving environment. WHAT YOU'LL NEED Education: High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education. Experience/Technical Skills: Experience in Ordering/Quoting systems is desired (AccuQuote preferred). Experience with CRM systems is desired. Additional Information All your information will be kept confidential according to EEO guidelines. Why work for Cornerstone Building Brands? Our teams are at the heart of our purpose to positively contribute to the communities where we live, work and play . Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development. *Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement. Cornerstone Building Brands is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster here . You can also view Your Right to Work Poster here along with This Organizations Participation in E-Verify Poster here . If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or [email protected] . If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or [email protected] . This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response. All your information will be kept confidential according to EEO guidelines. California Consumer Privacy Act (CCPA) of 2018 Must be at least 18 years of age to apply. Notice of Recruitment Fraud We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.

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: $63,800 - $78,000 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. We can recommend jobs specifically for you! Click here to get started.

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're Hiring: Claims Clerk (California) | On-site 🌍 This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise. Why Join Crawford & Company? ✅ Offers Opportunity to Grow Your Network ✅ Salary: $24,531.51 - $44,850.11 / Annually ✅ Excellent Crawford Benefits that Empower Financial, Physical, and Mental Wellness ✅ Generous Employee Referral Bonus Program ✅ Access to Multiple Employee Discounts 📝 Role Overview: 📂 Under direct supervision, performs a variety of claim clerical support duties for the Service Center or for the Claim Office. High school diploma or GED; or the equivalent in related work experience. Must demonstrate basic knowledge of computer operations and of claim file systems and procedures. 2 yrs administrative experience preferred but not required. Proficient in the Microsoft suite of products and like systems. Must be capable of working in a fast paced environment. Must be flexible, adaptable, and have excellent multi-tasking skills. Must be technically proficient. Excellent oral and written communication skills are essential. #LI-EM3 Matches proper file and/or claim number on unidentified correspondence by use of the various automated systems for mail delivered by USPS/ACS/Unmatched mail queue in ODM. Types a variety of material such as letters, benefit notices, or memorandums for medical appointment, attorneys, or external clients. Performs control operator functions for various Service Center or Claim Office data systems. Retrieves and/or re-files items from central storage facility and maintains accurate records of file activity. Receives dock and messenger service deliveries and verifies accuracy of delivered material. Prepares outgoing mail for shipment which includes the necessary attachments, wrapping, and sealing. This will include shipping/receiving computer equipment. Performs a variety of clerical duties such as answering telephones, taking messages, dispersing faxes, making payments, sort/preparing files, and data entry. Assists in updating jurisdictional notices and manuals used in the office. Pulls files from storage for in-house state audits. Prepares files in electronic form for state audits (payment history, file notes, and gathering medical reports). Contacts agents and insured on routine claims to obtain coverage information or obtains through the various systems. Issues payments, requests wage information for the adjusters, orders surveillance, and completes medical calls to obtain the current work status. Schedules medical appointments and sends all appropriate correspondence relating to that appointment. Performs other related work as required or requested. Upholds the Crawford Code of Conduct.

Why CIG? At Capital Insurance Group we offer our employees more than just a job. We foster career growth, provide opportunities to give back to our communities, and help you take the next step in your career! CIG was founded in 1898 by a group of earnest farmers in need of protection and today, we are the leading West Coast Property & Casualty insurer. CIG is certified as a Great Place to Work and provides a collaborative, inclusive, and fun work culture for all employees. Why choose CIGs Claims Team? CIG claims department is here to support our insureds throughout their claims process. We work directly with our agency partners and policyholders to accomplish successful claim resolutions. Join the claims operation and you can be part of a team who provides excellent service, build relationships, and achieves successful outcomes for our clients. Learn what it means to be a Claim Representative III - Property at CIG