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Claims Examiner I - Commercial Auto
Athens Administrators 4.0
Claim processor job in Parsippany-Troy Hills, NJ
Details Claims Examiner I - Commercial Auto Department: Property & Casualty Reports To: Claims Supervisor FLSA Status: Exempt in all state except California Job Grade: 9 Career Ladder: Next step in progression could include Claims Examiner II ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Claims Examiner I to support our Property & Casualty department. Employees who live less than 26 miles from the San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA, and WV). Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday through Friday at 37.5 hours per week. The Claims Examiner I is responsible for the timely investigation, evaluation and determination of settlement or denial of minor to moderate multi-line auto property and casualty claims with a docus on trucking and property damage claims. They will be handling claims from inception to closure. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Knowledge in the following areas: 1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated analytical, decision making and negotiation skills. Investigate coverage, including evaluate insurance coverage problems and/or disputes Investigate, evaluate and determine settlement value or denial of liability for all claims Develop a measure of damage for each loss, establish and maintain appropriate reserves Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure Ensure appropriateness of all payments Negotiate settlement of claim within individual authority ($15,000 unless otherwise noted) Maintain and update action plans for each claim May assign and coordinate with vendors, legal counsel, appraisers or experts as necessary Facilitate between claimants, clients, brokers and attorneys in resolution of liability claims Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers Provide customer service and support to insureds and claimants Assist in training of new employees Attend meetings and educational seminars for professional development Maintain required licenses ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL Additional State Adjuster License(s) may be required within 180 days Maintain licenses and continuing education requirements in all states Minimum of three years auto-claims handling experience, at least one-year commercial auto required Trucking experience preferred Knowledge of property and casualty insurance policies Knowledge of auto insurance laws, codes, procedures, and liability concepts Proficiency in investigation and resolution of minor to medium level auto physical damage casualty claims Strong negotiation skills and ability to achieve optimal settlement results for clients. Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor. Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here
$51k-77k yearly est. 60d+ ago
Claims Specialist, APH
Swiss Re 4.8
Claim processor job in Armonk, NY
Imagine a role where you can directly influence the profitability of a business, steer a diverse portfolio of claims, and build lasting relationships with clients. If you're a self-motivated individual who thrives on collaboration and career growth, this challenge is for you! If this sounds interesting, join us at Swiss Re, where we believe in fostering an environment that sparks the best ideas, maintaining a sensible work-life balance, and producing outstanding results through engaged employees. Together, we can help make the world more resilient. About the Role As a Reinsurance Claims Specialist at Swiss Re, you'll manage a portfolio of asbestos, pollution, and health hazard (APH) reinsurance claims across various lines of business for both active and runoff portfolios. This role offers a unique opportunity to collaborate across functions, develop broad knowledge about the insurance and reinsurance industry, and help steer the business through data-driven insights and strong client partnerships. Key activities of the role include: * Steer a diverse portfolio of multi-line reinsurance claims, ensuring strategic performance through data analysis and industry insight. * Analyze contractual obligations, establish and monitor reserves, and approve payments within authority to ensure timely, effective resolution. * Apply advanced data analytics and reporting tools to manage the portfolio and identify emerging trends. * Collaborate with Underwriting, Actuarial, and other teams to provide portfolio insights that inform business strategy and decision-making. * Formulate, develop, and implement account management, including building and supporting client relationships. * Participate in client meetings and audits to review claims, assess claims-handling practices, and support collaborative problem-solving. * Deliver high-quality claims and client service, sharing industry knowledge and contributing to continuous improvement initiatives. * Support internal stakeholders with research on claim topics, loss development, and contract wording issues, while ensuring compliance with governance, legal, and reporting requirements. About the Team You'll join a team of APH claims professionals known for deep technical expertise, collaborative spirit, and innovative problem-solving. We work closely with clients and internal partners to deliver exceptional claims management, identify potential exposures, and provide meaningful insights that shape our business. If you're curious, analytical, and motivated by teamwork and impact, this is the place for you. About You You excel in a dynamic environment, adept at juggling multiple priorities while maintaining professionalism. With strong interpersonal skills, you're confident communicating with clients, legal counsel, and senior management, and you bring curiosity and strategic thinking to every challenge. Additional requirements include: * Bachelor's degree required. * At least 2-5 years of experience in claims, underwriting, insurance, reinsurance, or insurance-related legal work, including handling latent direct insurance claims. * General understanding of and/or exposure to other insurance disciplines i.e., contract wording, accounting, underwriting. * Ability and passion to manage a complex portfolio with critical analysis and innovative strategic thought. * Confirmed ability to meet deliverables, implement plans, and conduct analysis. * Excellent writing skills and proficiency in MS Office tools, claims systems and the ability and willingness to learn new systems. * Excellent organizational and data analytics skills with openness for continued growth. * Ability and willingness to learn new claims handling systems. * Some business travel required. The estimated base salary range for this position is $84,000 to $140,000. The specific salary offered for this or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation. About Swiss Re Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world. Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability. If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience. Keywords: Reference Code: 136396 Nearest Major Market: White Plains Nearest Secondary Market: New York City Job Segment: Claims, Compliance, Accounting, Actuarial, Underwriter, Insurance, Legal, Finance
$84k-140k yearly 1d ago
Trucking Claims Specialist
Berkshire Hathaway 4.8
Claim processor job in Wilkes-Barre, PA
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. 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.
$44k-52k yearly est. Auto-Apply 27d ago
Complex Liability Claims Specialist - Primarily NY / New York Labor Law
Utica National Insurance Group 4.8
Claim processor job in New York
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier. Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago. What you will do The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in primarily New York venues, inclusive of New York Labor Law claims. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required. Key responsibilities * Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in primarily New York jurisdictions. * Manage all claims in accordance with Utica National's established claim procedures. * Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level. * Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy. * Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims. * Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials. * Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle. * Achieve the service standard of "excellent" during all phases of claims handling. * Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction. * Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling. What you need * Four year degree or equivalent experience preferred. * Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims. * Proven experience negotiating claims and active participation in alternative dispute resolution practices. * Experience with general liability, additional insured considerations and complex coverage determinations. * Experience with New York Labor Law Claims strongly preferred. Licensing Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment. Salary range: $103,300 - $136,400 The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications. Benefits: We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following: * Medical and Prescription Drug Benefit * Dental Benefit * Vision Benefit * Life Insurance and Disability Benefits * 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results) * Health Savings Account (HSA) * Flexible Spending Accounts * Tuition Assistance, Training, and Professional Designations * Company-Paid Family Leave * Adoption/Surrogacy Assistance Benefit * Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance * Student Loan Refinancing Services * Care.com Membership with Back-up Care, Senior Solutions * Business Travel Accident Insurance * Matching Gifts program * Paid Volunteer Day * Employee Referral Award Program * Wellness programs Additional Information: This position is a full time salaried, exempt (non-overtime eligible) position. Utica National is an Equal Opportunity Employer. Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy. #LI-HL1
$103.3k-136.4k yearly 19h ago
Claims Specialist
Berkley 4.3
Claim processor job in New Jersey
Company Details Berkley Luxury Group is an operating unit of W.R. Berkley Corporation, one of America's largest commercial lines writers in the United states. At Berkley Luxury Group we offer tailored, all-inclusive insurance solutions for luxury condo, co-op, rental properties and fine dining restaurants. Berkley Luxury Group has been a mainstay in the commercial real estate and hospitality business since 1986. We specialize in luxury condominiums, cooperatives, and apartments in the habitational space, Class A Office buildings and fine dining restaurants in the hospitality space. BLG maintains a standard of prompt and fair settlement of claims, and endeavors to treat insureds and brokers in a partnership-like manner. BLG has developed a strategic plan to grow their success by expanding their footprint geographically and adding complementary products. At BLG there is a shared vision to be the best option for its customers. We aim to provide comprehensive insurance solutions, use enhanced data and technology to make more informed decisions and rely on a field-based underwriting, claims and loss control model to be closer to our customers and brokers. Our goal is to provide superior services and products to these unique businesses. At Berkley Luxury Group, our employees are our most important asset. We recognize that if we properly support and develop our employees, they will become our primary sustainable competitive advantage and the key to achieving success. As such, we have created a high performing culture incorporating our values into work practices, policies, and processes to foster, reinforce and sustain an environment where employees share a strong sense of purpose, commitment, and motivation to meet and exceed their goals. As a Berkley company, we enjoy operational flexibility that allows us to deliver quality coverage solutions. W. R. Berkley Corporation, and all member insurance companies, are rated A+ (Superior) by A.M. Best Company and carry Standard & Poor's Financial Rating of A+ (Strong). The company is an equal opportunity employer. Responsibilities Berkley Luxury is seeking a Senior Claims Specialist to join our team! This role is located is our new Parsippany NJ office. As a Claim Specialist, you will manage a wide range of commercial lines casualty claims, focusing on developing and implementing effective resolution strategies while delivering exceptional customer service. In this role, you will ensure high-quality claims handling through investigation, accurate analysis of coverage and liability, precise damage assessment, and resolution of claims, including those in litigation. As a key member of the casualty team, you will also help foster a culture of accountability, collaboration, continuous learning, and proactive performance improvement-contributing to both departmental excellence and the overall success of the company. Conduct thorough investigation and expert analysis of claims facts to determine coverage, liability, and applies appropriate legal concepts to evaluate damages and recommend appropriate course of action. Analyze and interpret policy language and case law in conjunction with specific loss facts to reach appropriate coverage decisions and write appropriate coverage correspondence in compliance with state statutes and regulations. Demonstrate a strong sense of urgency in promptly conducting comprehensive claims investigations to assess damages and liability, establish accurate reserves, and actively pursue timely and appropriate resolutions. Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposures, risk transfer, reserve adjustments, coverage issues, and claim resolution strategies. Resolve claims through negotiation, mediation, and arbitration with minimal assistance. Address inquiries from brokers and policyholders and provide superior customer service. Attend and participate in industry related conferences, seminars, and webinars and demonstrating a personal commitment to professional development. Ensure claims handling compliance and alignment with insurance regulations and Company policies. May participate in projects and other corporate initiatives such as audits, task forces, focus groups, etc. Other duties as required. Qualifications Education Bachelor's degree or equivalent experience JD degree a plus Experience 5-7 years of experience handling commercial general liability claims. Experience managing litigated claims and working with defense counsel. Proven track record of effective claims resolution and negotiation. Technical Skills Strong knowledge of claims investigation techniques, liability assessment, and damage evaluation. Demonstrated expertise in legal processes and litigation management. Ability to interpret and apply policy language accurately. Analytical & Decision-Making Demonstrated critical thinking and sound judgment in analyzing claims. Advanced analytical abilities to evaluate liability, quantify damages, and determine exposure. Proven capacity to make prompt, well-reasoned, and evidence-based decisions. Communication & Interpersonal Excellent written, verbal, and presentation communication skills. Effective communicator with diverse stakeholders, including policyholders, claimants, attorneys, and internal teams. Strong negotiation skills Organizational & Time Management Strong organizational skills with attention to detail. Effectively manages priorities and meets deadlines in a fast- paced environment. Team & Culture Fit Takes ownership, shows initiative, and approaches problem-solving with a proactive mindset. Collaborative team player dedicated to achieving shared goals. Committed to continuous improvement and ongoing professional development. Supports and upholds the company's commitment to equal employment opportunity. Additional Company Details The company is an equal opportunity employer. We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role includes: Base Salary Range: $83,000 - $156,000 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. Eligible to participate in the annual discretionary bonus program. Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
$83k-156k yearly Auto-Apply 8d ago
Executive Claims Specialist - Gig Economy
Cfins
Claim processor job in Morristown, NJ
Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description S&S Transportation & Sharing Economy is seeking an experienced Executive Claims Specialist to join our dynamic team. In this role, you will provide expert oversight of Bodily Injury (BI); Property Damage (PD) and Personal Injury Protection (PIP) claims managed by Third-Party Administrators (TPAs), specifically arising from rideshare-related incidents. The ideal candidate will possess substantial expertise in complex injury claims, with a strong background in the rideshare sector. What you will do for C&F: TPA Oversight: Provide technical supervision and guidance for BI and PIP claims handled by TPAs, ensuring adherence to program standards and best practices. Claims Management: Apply advanced knowledge to oversee rideshare claims, including coverage analysis and litigation management. Technical Excellence: Drive optimal claim outcomes by controlling indemnity, expense, and litigation costs through timely reserving, trial preparation, and resolution strategies. Auditing: Conduct regular audits of TPA-managed claims to ensure accuracy, timeliness, and compliance with established procedures. Data Analysis: Review claims data, reserve adequacy, and performance metrics to identify trends and recommend process improvements. Industry Awareness: Stay informed on evolving rideshare regulations, policy changes, and litigation developments. Additional Duties: Perform other related tasks as assigned. What you will bring to C&F: Experience: Minimum 6-8 years handling complex bodily injury and litigated claims, with direct experience in rideshare claims required. Expertise: In-depth knowledge of BI and PIP claim procedures; experience with high-value BI, PIP, and Property Damage exposures related to rideshare incidents. Education: Bachelor's degree required; law degree, professional designations, or insurance coursework a plus. Licensing: Ability to obtain and maintain required state licenses. Communication: Excellent verbal and written communication skills, with the ability to interact effectively at all organizational levels. Technical Skills: Proficiency in Microsoft Office suite. Travel: Occasional travel may be required. Risk Transfer: Understanding of claims policy language and coverage necessary to evaluate Risk Transfer with PAP carriers. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $64,700.00 to a maximum of $121,600.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-AV1 #LI-Remote
$64.7k-121.6k yearly Auto-Apply 1d ago
Associate Claims Examiner
Markel 4.8
Claim processor job in New Jersey
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills. Associate Claims Examiner will be responsible for the resolution of claims with the Prompt Resolution Team (PRT) of lower complexity and exposure. This position will have decision-making authority in the amount of $25,000 and work under the general direction of their manager. The ACE position supports all product lines in Casualty with particular emphasis on Binding and Commercial Wholesale Primary and Small Commercial Programs. Job Responsibilities Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Conducts, coordinates and directs investigation into loss facts and extent of damages. Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure. Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents. Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting. Required Qualifications Must have or be eligible to receive claims adjuster license. Successful completion of basic insurance courses or achievement of industry designations. Ability to be trained in insurance adjusting up to two years of claims experience. 2-4 years of experience in general liability, construction defect, or related liability lines preferred. Bachelor's degree preferred Excellent written and oral communication skills. Strong organizational and time management skills. # LI-Hybrid US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Pay information: The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $25 - $38.25 with a 10% bonus potential. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose ‘Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.
$49k-72k yearly est. Auto-Apply 38d ago
Workers' Compensation Claims Supervisor (CA)
Berkshire Hathaway Guard Insurance Companies 4.4
Claim processor job in Wilkes-Barre, PA
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 As a Claims Supervisor in our Complex Unit overseeing California jurisdiction, lead a workers' compensation claims team focused on quality, timeliness, compliance, and financial stewardship. You'll coach adjusters, manage performance, and maintain a small caseload to stay connected to the work. Key Responsibilities Mentor and develop adjusters, conduct performance reviews, and ensure coverage for absences. Provide timely guidance, complete audits, and enforce state/NCCI standards. Maintain reserve adequacy, complete reinsurance reports, and monitor legal/ALAE costs. Supervise high-value and denied claims, ensure timely updates, and escalate as needed. Use dashboards to track productivity, manage workflows, and support return-to-work initiatives. Communicate policy changes, identify process enhancements, and foster team engagement. Qualifications What you'll bring 5+ years in CA workers' compensation claims, 2+ years in a supervisory or lead role (or equivalent experience). Experience handling litigated claims. Active adjuster's license. Expertise in audits, reserves, compliance, and litigation strategy. Strong analytical, communication, and leadership skills; comfortable with data-driven tools.
$63k-99k yearly est. Auto-Apply 60d+ ago
Claims Specialist - Auto
Philadelphia Insurance Companies 4.8
Claim processor job in Harrisburg, PA
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 Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS 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. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. 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 *****************************************
$82.8k-97.3k yearly Auto-Apply 60d+ ago
Medical Claims Representative - Paid Family Leave/Disability
Guard Insurance Group
Claim processor job in Wilkes-Barre, PA
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 The Paid Family Leave/Disability Representative is responsible for communication, coordination, and administration of Paid Family Leave/Disability Claims within the state of New York. This includes determination of compensability and the prompt provision of benefits. The position will work as a liaison between the employer and employee to provide information about Paid Family Leave/Disability. The representative is responsible in informing employers on the proper management and impact of Paid Family Leave/Disability claims. Qualifications Candidate must have the following skills: * Computer Literacy with strong Microsoft Office capabilities * Excellent communication and organizational skills * Proficiency in understanding medical and legal terminology * Strong attention to detail and focus on technology * A solid commitment to providing exceptional customer service * Able to successfully pass adjuster licensing exam upon hire
$37k-58k yearly est. Auto-Apply 6d ago
Claims Specialist
Sourcepro Search
Claim processor job in New York, NY
SourceProSearch is seeking a Claims Specialist with 1-2 years of experience to work in our New York office. The ideal candidate should be comfortable with technology and platforms. This position requires at least 2 days per week in the office. Job Responsibilities: Format documents and communications for clients. Liaise between third-party vendors and the firm. Review documents (release/document verification) for production to defense counsel for quality control. Calendaring and entry of case info into the database. Perform intake and initial filtering of client inquiries. Preparation of submissions involving large volumes of individual claims. Run and analyze client data reports. Organize documents and communications with clients. Ensure that case documents accurately reflect a client's individual information. Keep track of communications or developments relating to client cases and deadlines that may be applicable to individual clients. Prepare and send client communications. Communicate with clients telephonically, on occasion. Work with attorneys to plan data gathering and settlement update workflows. Analyze and summarize client inquiries to identify trends and patterns requiring further action. Assist with the development of processes and technological systems for addressing large volumes of client interactions. Skills/Requirements: Proficient in the use of Microsoft Word and Excel. Familiarity with Filesite preferred. Familiarity with client management systems or databases preferred. Strong technical skills and ability to quickly learn new litigation support software. Strong written and oral communication skills and strong interpersonal skills. Must possess great attention to detail. Must possess analytical and critical thinking skills. Strong organizational and time-management skills. Ability to work independently while understanding the importance of teamwork. Ability to manage workload consisting of multiple tasks. The work shift for this position is 9:30 am-5:30 pm, five days a week, but the applicant must be willing and available to work overtime, both evening and weekends, when necessary. ****************************
$43k-77k yearly est. 60d+ ago
Complex Claims Specialist - MPL
Hiscox
Claim processor job in New York
Job Type: Permanent Build a brilliant future with Hiscox Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required. Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations: Manhattan, NY West Hartford, CT Atlanta, GA Chicago, IL The Role: The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also: Adjusts and resolves complex to severe claims that includes all phases of litigation With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters Reviews and analyses claim documentation and legal filings Drives litigation best practices to lead defense strategy on litigated files Mentors Claim Examiners Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions Identifies emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with special investigations unit Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities Develops content and conducts training for claims team and underwriters as requested The Team: The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling. Requirements: 8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.) Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Experience in mentoring and training other claims examiners Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University preferred Additional Factors Considered Ability to act a subject matter expert within team Demonstrated ability to work with minimal oversight Experience attending and leading mediations, arbitrations and trials Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars. What Hiscox USA offers 401(k) with competitive company matching Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) Company paid group term life, short- term disability and long-term disability coverage 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days Paid parental leave 4-week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing 2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox As an international specialist insurer we are far removed from the world of mass market insurance products. Instead we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things. We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions. Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places. Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch. About Hiscox US Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. Diversity and flexible working at Hiscox At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range $100,000 - $155,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-AJ1 Work with amazing people and be part of a unique culture
$43k-75k yearly est. Auto-Apply 60d+ ago
Cyber Claims Specialist
Sea Wolf Executive Search
Claim processor job in New York
We are seeking a Complex Cyber Claims Specialist to join our team of dedicated professionals in the insurance industry. As a Complex Cyber Claims Specialist, you will be responsible for handling complex cyber claims for our clients. The ideal candidate for this position will have several years of cyber claims handling experience (JD preferred but not required). Responsibilities: Investigate and evaluate complex cyber claims to determine coverage and liability. Analyze legal and technical issues related to cyber claims. Work with attorneys, experts, and other professionals to resolve complex claims. Develop and maintain strong relationships with clients, brokers, and underwriters. Provide guidance and support to other claims professionals. Ensure compliance with company policies and procedures. Monitor trends and developments in the cyber insurance industry. Requirements: Several years of cyber claims handling experience, (JD is preferred but not required). Strong analytical and problem-solving skills. Excellent communication and interpersonal skills. Ability to work independently and as part of a team. Familiarity with insurance policies and coverage. Knowledge of cyber risk and related legal issues. Strong attention to detail and organizational skills. Ability to handle multiple tasks and priorities. Benefits: We offer a competitive salary dependent upon experience, a bonus anywhere from 10-20%, flexible work schedule, and great benefits including medical, dental, vision, life insurance, and 401(k) retirement plan. The work week is 35 hours. If you are looking for an exciting opportunity to join a leading international insurance carrier and work with a team of dedicated professionals, we encourage you to apply for this position.
$43k-75k yearly est. 60d+ ago
Claims Specialist 3- Staffing
Circet USA
Claim processor job in Englewood Cliffs, NJ
Job Description Circet USA is the leading provider of Network Services in North America, and we're looking for talented professionals to join our team. We specialize in engineering and construction services delivering comprehensive solutions across Inside Plant, Outside Plant, and Wireless networks to meet the evolving infrastructure needs of our customers. With nearly 50 years of industry experience, we work with major telecom service providers, MSOs, cloud service providers, and utilities. At Circet USA, you'll have the opportunity to make an impact by helping to create customized solutions that address our clients' unique challenges. If you're passionate about innovation and thrive in a dynamic environment, we'd love to hear from you. Circet USA's benefits package includes the following: Medical, Dental, and Vision insurance Digital Health & Wellness Support Critical Illness, Accident, & Hospital Insurance Short-term & Long-term disability Group term & Voluntary life insurance Flexible Spending and Health Savings Accounts Paid Time Off & 401K Company Discount Website Responsibilities We are seeking a highly skilled and experienced Claims Specialist 3 to fulfill a staff augmentation role with Circet USA's customer. The primary objective of the Claims Specialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the Claims Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable. ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties may be assigned: Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators. Generate daily/weekly/monthly reports, with analysis and recommendations Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics Ensure that all projects have required documentation as they move through the project tollgates Communicate to Product Liability leadership on project status and escalation/decision points Works cross functionally with HQ teams in Korea (occasional evening conference call) and SEA operations to manage all possible risks. Pending Claim Management, KPI & TAT Management - Claim registration to closure Product Verification Liability Assessment by reviewing diagnosis results Reporting on high-profile claims to the leadership Qualifications Bachelor's Degree (or equivalent experience) 3-5 years of hands-on claims management & customer care experience Expertise in MS, Excel, and PPT Proven capability to analyze data and develop a course of action Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution Process, procedure, strategic planning and project development experience Experience working with and influencing cross-functional teams. Experience working within the insurance and/or home appliance industry a plus Experience with product development or testing a plus Experience working in a complex and wide organization and department Claims Adjuster License a plus Takes project ownership and possess leadership qualities with an entrepreneurial approach Circet USA is an Equal Opportunity Employer - Veteran/Disabled. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by law.
$44k-79k yearly est. 23d ago
Insurance And Claims Specialist I
Health Research, Inc. 4.5
Claim processor job in Menands, NY
Applications to be submitted by January 05, 2026 Compensation Grade: P14 Compensation Details: Minimum: $53,357.00 - Maximum: $53,357.00 Annually Positions with a designated work location in New York City, Nassau, Rockland, Suffolk, or Westchester Counties will receive a $4,000 annual downstate adjustment (pro-rated for part-time positions). Department (OHEHR) AI - AIDS Institute Job Description: Responsibilities The New York State Department of Health, AIDS Institute has established eight Uninsured Care Programs, of which some of these programs have the most comprehensive drug and service coverage in the country. The programs provide access to medical services and medications for all New York State residents with or at risk of acquiring HIV/AIDS. The programs bridge the gap between Medicaid coverage and private insurance and serve as a transition to Medicaid by providing interim assistance to individuals eligible for but not yet enrolled in Medicaid or assistance in meeting spenddown requirements. The Insurance and Claims Specialist I will be responsible for APIC reimbursement processing; pharmacy, primary care, home care and APIC payment processing; handle complex fiscal hotline calls; assist providers and participants with the coordination of benefits; assist with staff training; other appropriate related duties. Minimum Qualifications Bachelor's degree in a related field; OR an Associate's degree in a related field and two years of general office, secretarial, or administrative experience; OR four years of such experience. Preferred Qualifications At least one year of experience in a health care program providing services to people living HIV/AIDS. At least two years of customer service experience in a financial or medical field. At least two years of medical claims or insurance experience. Knowledge of COBRA, HIPAA, and coordination of benefits. Conditions of Employment Grant funded position. Compliance with funding requirements such as time and effort reporting, grant deliverables, and contract deliverables, is required. Valid and unrestricted authorization to work in the U.S. is required. Visa sponsorship is not available for this position. Prior to hire, all HRI employees must reside within a reasonable commuting distance of their official work location and must also be located in, or willing to relocate to, one of the following states: New York, New Jersey, Connecticut, Vermont, or Massachusetts. Telecommuting will not be available. HRI participates in the E-Verify Program. Affirmative Action/Equal Opportunity Employer/Qualified Individuals with Disabilities/Qualified Protected Veterans ********************** About Health Research, Inc. Join us in our mission to make a difference in public health and advance scientific research! At Health Research, Inc. (HRI), your work will contribute to meaningful change and innovation in the communities we serve! At HRI, we are on a mission to transform the health and well-being of the people of New York State through innovative partnerships and cutting-edge public health initiatives. As a dynamic non-profit organization, HRI plays a crucial role in advancing the strategic goals of the New York State Department of Health (DOH), Roswell Park Comprehensive Cancer Center (RPCCC), and other health-related entities. HRI offers a robust, comprehensive benefits package to eligible employees, including: Health, dental and vision insurance - Several comprehensive health insurance plans to choose from; Flexible benefit accounts - Medical, dependent care, adoption assistance, parking and transit; Generous paid time off - Paid federal and state holidays, paid sick, vacation and personal leave; Tuition support - Assistance is available for individuals pursuing educational or training opportunities; Retirement Benefits - HRI is a participating employer in the New York State and Local Retirement System and offers optional enrollment in the New York State Deferred Compensation Plan. HRI provides a postretirement Health Benefits Plan for qualified retirees to use towards health insurance premiums and eligible medical expenses; Employee Assistance Program - Provides educational and wellness programs, training, and 24/7 confidential services to assist employees, both personally and professionally; And so much more!
$53.4k yearly Auto-Apply 1d ago
Ambulatory Care Capacity Analyst - Jefferson Medical Group - Center City
Kennedy Medical Group, Practice, PC
Claim processor job in Philadelphia, PA
Job Details The Ambulatory Care Capacity Analyst provides strategic support for provider access initiatives across the Jefferson Medical Group (JMG). This role provides internal schedulers and patients a standard, comprehensive approach to appointment availability across the enterprise. Job Description Essential Functions: Responsible for building, maintaining, and modifying centralized scheduling templates for all scheduling providers, including resource providers · Ensure all approved template changes follow change management procedures and protocols and align with Jefferson's template strategy guidelines Provide impact analysis for master template changes Report, review, and reschedule patient appointments as indicated by the Reschedule List Collaborate with Ambulatory practice administrative and clinical leadership on template optimization through the use of Epic Cadence functionality and advise on best practices Participate in department meetings that address patient access-related metrics Identify potential access limiting factors and develop possible solutions for department collaboration Monitor the effectiveness of access-related initiatives using data analysis via Qlik Reporting, Epic Reporting Workbench, and excel Strategize operational and technical methodologies to enhance patient self-scheduling for both patients and the ambulatory practices Present, demonstrate, and train internal staff on access and capacity strategies and initiatives On-board providers on scheduling decision tree and open scheduling platforms Rotate with peers for on-call schedule Education and Experience: High School Diploma Required; Bachelor's Degree preferred. Epic Cadence or other Epic application certification - plus. Minimum 2-3 years experience in an ambulatory care or IT setting preferred. Prior scheduling template management experience preferred. Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Jefferson University Physicians Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educa tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance. For more benefits information, please click here
$33k-52k yearly est. Auto-Apply 39d ago
Claims Specialist
Connectiverx 3.7
Claim processor job in New Jersey
Being on medication is tough enough. We want to make getting it the easy part. Getting prescriptions to patients has become increasingly complex. When things get messy along the prescription journey, pharmaceutical manufacturers rely on us to untangle the process and create a clear path-allowing patients to build trusting relationships with their medication brands. We're not only committed to taking the pain out of the prescription process, but we're also devoted to bringing the brightest minds together under one roof. We bring together diverse voices-engineers, pharmacists, customer service veterans, developers, program strategists and more-all with one vision. Each perspective and experience makes ConnectiveRx better than the sum of its parts. The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is responsible for processing medical claims received from patients and/or HCPs across a broad product suite. An individual in this role is expected to meet or exceed productivity and quality standards. Associates possess a solid understanding of department processes, products, and operational tools/systems. This position utilizes ConnectiveRx and 3rd party systems to process claims and respond to inquiries from patients, physicians, pharmacies, and clients. The Associate may be assigned additional responsibilities by the Supervisor. Responsibilities Verifies the accuracy and completeness of claim forms and attachments, such as EOBs, EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid or rejected based upon system adjudication and/or application of business rules external to the systems. Consult with the Team Lead or Supervisor for complex claims or clarification of business rules. Obtains missing information by calling or writing customers using standard scripts or form letters. Based on volume, may also process claims and/or answer phones Refers to requests for escalation as needed and engages other internal areas such as Program Management, IT, and other Contact Center teams to resolve issues. Provide input and feedback to the Supervisor, Quality Management, and Training (among others) to improve processes, procedures, and training. Other projects and tasks as assigned Qualifications High School or GED required 1+ years in a health care or case management setting Experience working in pharmacy benefits, health care insurance, and/or medical billing a must Health care or pharmaceutical experience, particularly in a medical claims processing, billing provider, or insurance environment Knowledge of EOB and EOP statements Prior experience in a high-volume processing setting (i.e., doctor's office, claims processing department, etc.) a plus. Will be trained to support programs, clients, and/or job functions as appropriate Experience with Third-Party systems (SelectRx, Pro-Care, FSV) (preferred) Fluent in English/Spanish (a plus). Knowledge of Medical Claims processing/billing coding Communication skills: Uses writing effectively to create documents, uses correct spelling, grammar, and punctuation; Ability to convey written and verbal information in easy-to-understand language. Customer Focus: High level of empathy and emotional intelligence; Focuses on the opportunity to service patients with a high level of empathy Detail Oriented: Achieves thoroughness and accuracy when accomplishing a task Adaptability: Adapts to a variety of situations easily and effectively navigates situations Problem Solve; Thinks critically, and problem-solves issues to resolution Compensation & Benefits: Compensation for this role varies based on factors such as location, relevant skills, experience, and capabilities. Employees at ConnectiveRx can enroll in comprehensive benefit plans, including medical, dental, vision, life, and disability insurance. The company retains the right to update or modify health, welfare, and other fringe benefit policies. Employees may also participate in the company's 401(k) plan. Time-Off & Holidays: ConnectiveRx provides paid time off (PTO) to non-exempt employees for vacations and personal leave. For sick leave, eligible non-exempt employees receive Sick Time Off (STO) in accordance with company policy. PTO and STO are prorated during the first year of service. Employees also receive eight standard company holidays and three floating holidays annually, with floating holidays prorated in the first year. The company is committed to maintaining competitive benefits and reserves the right to adjust employee offerings, including PTO, STO, and holiday policies, in compliance with applicable laws and regulations. Posted Salary Range USD $17.51 - USD $22.95 /Hr.
$17.5-23 hourly Auto-Apply 7d ago
Claims Specialist
Sales Match
Claim processor job in Newark, NJ
Job Title: Remote Claims Specialist Hourly Pay: $22 -$27/hour We are looking for a skilled Claims Specialist to join our work-from-home team. In this role, you will assist in processing and reviewing insurance claims, ensuring all necessary information is gathered, and helping resolve claims efficiently. If you have strong attention to detail and enjoy supporting customers through the claims process, this is a great opportunity for you. Key Responsibilities: Assist in processing insurance claims, ensuring accuracy and timely resolution Review claims documentation, including reports, medical records, and other evidence Communicate with claimants, insurance adjusters, and third parties to gather information Help resolve disputes or issues with claims and escalate when necessary Maintain detailed records of claims progress and updates Ensure compliance with industry regulations and internal policies Provide excellent customer service and answer inquiries related to claims Qualifications: Experience in insurance, claims handling, or a related field Strong attention to detail and organizational skills Excellent communication and customer service abilities Ability to handle multiple claims and prioritize effectively in a remote environment Familiarity with insurance policies and claims procedures is a plus Must have reliable internet and a quiet, dedicated workspace Perks & Benefits: 100% remote work flexibility Competitive hourly pay: $22 - $27 Paid training and professional development opportunities Flexible work hours, including evening and weekend options Opportunities for career growth in the insurance industry A supportive and team-oriented work environment
$22-27 hourly 60d+ ago
Litigation Claims Specialist
Questor Consultants, Inc.
Claim processor job in Deptford, NJ
Job DescriptionRisk Intermediary located in New Jersey seeks a VP of Claims for a Municipal Insurance fund. Claims handled are Workers Comp, Property and Liability and Professional Liability. Fund has 28 members submitting New Jersey based Public Entity based claims. This position will lead operational and administrative claims functions including reserving. Will also manage TPA relationships and direct TPA's Workers Comp activities. Will also manage staff Liability Litigation Managers and lead claims reporting. Require JD with 20 years experience in an Insurance Claims Department, TPA or Risk Management Department. Knowledge of New Jersey Civil Tort and Workers Comp claims systems. Advanced skills in Coverage Analysis, Litigation Management and Negotiation. Auto Liability, General Liability and Employer Liability claims. Knowledge needed in MS Office Products (Word, Excel and Powerpoint). Will work remote but must be within driving distance of office. Will manage 9-12 people. Minimal travel. Salary $150-200k no bonus opportunity.
$45k-80k yearly est. 25d ago
Pharmacy Claims Adjudication Specialist
Onco360 3.9
Claim processor job in Buffalo, NY
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $21.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion
$21 hourly 21d ago

Learn more about claim processor jobs

How much does a claim processor earn in Scranton, PA?

The average claim processor in Scranton, PA earns between $21,000 and $68,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average claim processor salary in Scranton, PA

$38,000

$21,00010%

$38,000Median

$68,00090%

What are the biggest employers of Claim Processors in Scranton, PA?

The biggest employers of Claim Processors in Scranton, PA are:

Imagenetllc

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Claim processor jobs in Scranton, PA

Claims Examiner I - Commercial Auto

Claims Specialist, APH

Trucking Claims Specialist

Complex Liability Claims Specialist - Primarily NY / New York Labor Law

Claims Specialist

Executive Claims Specialist - Gig Economy

Associate Claims Examiner

Workers' Compensation Claims Supervisor (CA)

Claims Specialist - Auto

Medical Claims Representative - Paid Family Leave/Disability

Claims Specialist

Complex Claims Specialist - MPL

Cyber Claims Specialist

Claims Specialist 3- Staffing

Insurance And Claims Specialist I

Ambulatory Care Capacity Analyst - Jefferson Medical Group - Center City

Claims Specialist

Claims Specialist

Litigation Claims Specialist

Pharmacy Claims Adjudication Specialist

Learn more about claim processor jobs

How much does a claim processor earn in Scranton, PA?

What are the biggest employers of Claim Processors in Scranton, PA?