Claim processor jobs in Shelton, CT

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Claims Division is seeking a team member to join the Shared Services Team as a Claims Examiner. Responsibilities include investigating, evaluating and resolving various types of commercial first and third party low complexity claims. This requires accurate and thorough documentation, as well as completion of resolution action plans based upon the applicable law, coverage and supporting evidence. Responsibilities: * Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level * Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution * Review and analyze supporting damage documentation * Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions * Establish appropriate loss and expense reserves with documented rationale * Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines Experience & Qualifications * Hands-on experience and strong aptitude with Outlook, Microsoft Excel, PowerPoint, and Word * Knowledge of ImageRight preferred * Exceptional communication (written and verbal), influencing, evaluation, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines * Ability to take part in active strategic discussions and leverage technical knowledge to make cost-effective decisions * Strong time management and organizational skills; ability to adhere to both internal and external regulatory timelines * Ability to work well independently and in a team environment * Texas Claim Adjuster license preferred, but not required for posting. Upon employment candidate would be required to obtain Texas Claim Adjuster license within six months of hire date. Education * Bachelor's degree preferred * 3-5 years' experience handling the process of commercial insurance claims #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $71,900 - $97,110/year * Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. * Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.

Required Qualifications (as evidenced by an attached resume): Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience. Preferred Qualifications: Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel. Brief Description of Duties: The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties: Duties: * Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims. * Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized. * Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc. * Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate. * Assist in the resolution of billing issues, i.e., WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error. * Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network. * Assist in the education of program guidelines and claims processes to external providers. * Assist in the maintenance of the comprehensive claims process, i.e. through input of suggestions for quality improvement or revisions to best practices. * Other duties or projects as assigned. Special notes: The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA. The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required. For this position, we are unable to sponsor candidates for work visas. Resume/CV and cover letter should be included with the online application. Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA. In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here. Visit our WHY WORK HERE page to learn about the total rewards we offer. SUNY Research Foundation: A Great Place to Work. The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting. '725271

Required Qualifications (as evidenced by an attached resume): Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience. Preferred Qualifications: Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel. Brief Description of Duties: The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties: Duties: Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims. Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized. Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc. Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate. Assist in the resolution of billing issues, i.e., WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error. Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network. Assist in the education of program guidelines and claims processes to external providers. Assist in the maintenance of the comprehensive claims process, i.e. through input of suggestions for quality improvement or revisions to best practices. Other duties or projects as assigned. Special notes: The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA. **The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required. For this position, we are unable to sponsor candidates for work visas. Resume/CV and cover letter should be included with the online application. Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA. In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here . Visit our WHY WORK HERE page to learn about the total rewards we offer. SUNY Research Foundation\: A Great Place to Work. The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting.

Claims Processor Required Qualifications (as evidenced by an attached resume):Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience. Preferred Qualifications: Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel. Brief Description of Duties:The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties: Duties:Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims. Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized. Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc. Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate. Assist in the resolution of billing issues, i. e. , WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error. Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network. Assist in the education of program guidelines and claims processes to external providers. Assist in the maintenance of the comprehensive claims process, i. e. through input of suggestions for quality improvement or revisions to best practices. Other duties or projects as assigned. Special notes:The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA. **The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required. For this position, we are unable to sponsor candidates for work visas. Resume/CV and cover letter should be included with the online application. Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA. In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here. Visit our WHY WORK HERE page to learn about the total rewards we offer. SUNY Research Foundation: A Great Place to Work. The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting. Job Number: 2504206Official Job Title: Clerical Specialist IIJob Field: Clerical/SecretarialPrimary Location: US-NY-CommackDepartment/Hiring Area: Dept of Med - WTCHPSchedule: Full-time Shift :Day Shift Shift Hours: 8:00am-4:00pm Posting Start Date: Dec 1, 2025Posting End Date: Dec 16, 2025, 4:59:00 AMSalary:$50,000-$56,000Appointment Type: RegularSalary Grade:N7 SBU Area:The Research Foundation for The State University of New York at Stony Brook

Claims Processor Required Qualifications (as evidenced by an attached resume):Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience. Preferred Qualifications: Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel. Brief Description of Duties:The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties: Duties:Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims. Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized. Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc. Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate. Assist in the resolution of billing issues, i. e. , WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error. Ensure that vendors and providers are in the WTCHP network, when necessary. Work with Claims Manager to have vendors and/or providers added to the network. Assist in the education of program guidelines and claims processes to external providers. Assist in the maintenance of the comprehensive claims process, i. e. through input of suggestions for quality improvement or revisions to best practices. Other duties or projects as assigned. Special notes:The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA. **The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required. For this position, we are unable to sponsor candidates for work visas. Resume/CV and cover letter should be included with the online application. Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at ************** or visit OEA. In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here. Visit our WHY WORK HERE page to learn about the total rewards we offer. SUNY Research Foundation: A Great Place to Work. The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting. Job Number: 2504206Official Job Title: Clerical Specialist IIJob Field: Clerical/SecretarialPrimary Location: US-NY-CommackDepartment/Hiring Area: Dept of Med - WTCHPSchedule: Full-time Shift :Day Shift Shift Hours: 8:00am-4:00pm Posting Start Date: Dec 1, 2025Posting End Date: Dec 16, 2025, 4:59:00 AMSalary:$50,000-$56,000Appointment Type: RegularSalary Grade:N7 SBU Area:The Research Foundation for The State University of New York at Stony Brook

Liberty Mutual has an immediate opening for a Complex Claims Specialist with Managed Care, Errors & Omissions (E&O) and Directors & Officers (D&O) Professional Liability claims experience. The Complex Claims Specialist, with minimal supervision, handles a book of specialty lines claims under E&O and D&O policies issued to health plans and other Managed Care Organizations throughout the entire claim's life cycle. In this role, you will be responsible for conducting investigations, evaluating coverage, setting adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business. * This position may have an in-office requirement and other travel needs depending on candidate location. If you reside within 50 miles of one of the following offices, you will be required to go to the office twice a month: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; Westborough, MA; or Weatogue, CT. Please note this policy is subject to change. Responsibilities * Analyzes, investigates and evaluates the loss to determine coverage and claim disposition. * Utilizes proprietary claims management system to document claims and to diary future events or follow up. * Issue detailed coverage position letters for all new claims within prescribed time frames. * Within prescribed settlement authority, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level. * Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting. * Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. * Pro-actively manages the case resolution process. Actively participates in mediations and arbitrations, as well as negotiation discussions within limit of settlement authority. * Participates in the claims audit process. * Provides claims marketing services by meeting with brokers and insureds. * As required, maintains insurance adjuster licenses Qualifications * Bachelors' and/or advanced degree * 7 + years claims/legal experience, with at least 2 years within a technical specialty preferred (Managed Care, Errors & Omissions and Directors & Officers) * Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge * Functional knowledge of law and insurance regulations in various jurisdictions * Demonstrated advanced verbal and written communications skills * Demonstrated advanced analytical, decision making and negotiation skills About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

Sr. Claims Analyst, Environmental Casualty - (25000048) Description Location: New York, NY, New Jersey, Farmington, CT, or other Allied World office locations. Job Summary:Investigate, evaluate, and resolve claims asserted against the Company's environmental policies. Engage in collaborative projects in support of other areas of the company, including underwriting, finance and accounting, actuarial, operations, and technology. Provide superior service to all customers, whether internal or external. Job Responsibilities:· Efficiently manage a vigorous load of claims involving a broad spectrum of accounts and coverages. Promptly analyze coverage, draft accurate and timely coverage positions, and manage litigation by effectively interacting with insureds, brokers, defense counsel, underwriters and other parties as required. Establish timely and appropriate reserves and regularly report claim developments and trends to claims and underwriting management. Represent Company in the resolution of claims and participate in legal proceedings, including mediations. · Work with other areas of the Company including underwriting, finance and accounting, actuarial, operations and technology on projects as requested. Prepare claim summaries and other reports as necessary for management. Prepare Executive Claim reports and present on a quarterly basis to senior executives. · Meet with existing or prospective clients and brokers. Attend relevant industry conferences/meetings. Qualifications CompensationThe below annualized base pay range is a broad range based on analysis of similar positions in the market. The actual base pay for the position may be above or below he listed range and determined by a number of considerations, including but now limited to complexity, location, and scope of the role, along with experience, skills, education, training, and other conditions of employment. Base salary represents one compensation of Allied World comprehensive total reward package, which may also include annual incentive compensation rewards. The salary range is flexible and will be determined according to the candidate's experience. $105,000 - $113,000Qualifications:· Minimum of 2 years' experience handling claims. · Four-year college degree is required. Knowledge of claims, legal and coverage issues in all U. S. jurisdictions. Excellent negotiation and communication skills. Strong technical skills and writing experience. Proficient with Microsoft Office products, internet research. Ability to accurately and timely analyze coverage, draft coverage position letters and interact and collaborate with counsel regarding litigation and coverage strategies, negotiate and resolve claims and otherwise act within the scope of delegated authority. Compliance with multi-state adjuster licensing requirements. Some travel required. About FairfaxFairfax is a holding company which, through its subsidiaries, is engaged in property and casualty insurance and reinsurance and investment management. About Allied WorldAllied World Assurance Company Holdings, Ltd, through its subsidiaries, is a global provider of insurance and reinsurance solutions. We operate under the brand Allied World and have supported clients, cedents and trading partners with thoughtful service and meaningful coverages since 2001. We are a subsidiary of Fairfax Financial Holdings, Limited and benefit from a strong capital base and a worldwide network of affiliated entities that allow us to think and respond in non-traditional ways. Our generous benefits package includes Health, Dental and Disability Insurance, a company match 401k plan, and Group Term Life Insurance. Allied World is an Equal Opportunity Employer. All qualified applicants will be considered for employment without consideration of any disability, veteran status or any other characteristic protected by law. To learn more, visit awac. com, or follow us on Facebook at facebook. com/alliedworld and LinkedIn at linkedin. com/company/allied-world. Primary Location: US-NY-New YorkOther Locations: US-CT-Farmington, US-NJ-IselinWork Locations: New York 199 Water Street New York 10038Job: ClaimsEmployee Status:RegularJob Type:StandardJob Posting: Oct 31, 2025, 1:02:59 PMMaximum Salary113,000. 00Pay BasisYearly

Claims Specialist, Professional Liability (also open to Senior Claims Specialist level) Hartford, CT Our Claims team sets us apart. Our experienced Claims professionals use their specialized expertise to handle the most complex claims seamlessly. How do you make a good thing better? You focus on excellence and creating a culture of continuous improvement. You create an environment that fosters collaboration, customer service and colleague development. As a Claims Specialist (also open to Senior Claims Specialist level) in the Hartford Professional claims unit, you will play a critical role by managing and resolving claims under various types of primary and excess professional liability policies, which could include public company directors & officers ("D&O") liability policies; financial institution D&O and errors & omissions ("E&O") policies; insurance company and insurance agents & brokers E&O policies; fiduciary liability policies; and employment practices liability policies. You will work closely with your manager to bring claims to resolution. You will interact and collaborate with regional practice leaders, our professional underwriters, brokers and clients on assigned accounts, taking ownership of critical issues relating to claims management. Our professional liability claims handlers are tasked with resolving and settling claims proactively in order to achieve exceptional outcomes. What you'll be DOING What will your essential responsibilities include? Proactively managing assigned professional liability claims across multiple lines of business, including initial analysis, drafting coverage letter, preparing a resolution strategy, and ensuring ongoing communication with stakeholders and claims management to achieve the best outcome for the client and AXA XL. Using robust technical skills, handle complex and difficult claims within authority level and specialization. Partnering with internal and external counsel in setting and pursuing effective and cost-efficient litigation strategies for claims in litigation, consistent with AXA XL litigation management best practices. Coordinating and managing communications with internal colleagues and key external stakeholders (e. g. , clients, brokers, reinsurers, vendors, etc. ), ensuring we are providing the highest level of customer service. Ensuring all documentation is present in the claim file and ensuring that Claims Handler Guidelines and protocols are followed. Managing expenses through thoughtful expense management and claims best practices. Assisting our underwriters with policy review and participating in external marketing and business development activities. Sharing lessons leaned and other identified trends to improve risk assessment and the underwriting process. Participating in the quality review procees and seeking to identify new and improved processes. Embracing short and long-term improvement initiatives. Producing internal reporting in support of best practices and reserving guidelines. Following the AXA XL Claim Alert process. Identifying, monitoring and reporting on emerging liability and coverage trends. Coaching less experienced colleagues and being a role model in best practices. You will report to Claims Manager, Hartford Professional. What you will BRING We're looking for someone who has these abilities and skills: Required Skills and Abilities: Education: Bachelor's degree required; Juris Doctor (JD) required. Experience: Professional liability claims-handling experience. Working knowledge of applicable regulations. Experience managing, negotiating and resolving high exposure and complex claims. Licensing: Insurance adjuster licenses for all states requiring licenses or willingness to immediately obtain such licenses upon starting. Proactive and Results Oriented File Handling: Ability to proactively manage assigned claims across multiple lines of the professional liability business. Approach tasks proactively and anticipate needs. Think quickly and prioritize multiple workstreams, while maintaining quality. Analytical and Technical Skills: Robust analytical and technical skills to handle complex and difficult claims. Sound judgment skills. Collaboration: Ability to collaborate with claims management on large and complex losses. Ability to develop and maintain productive working relationships with all colleagues, including insureds, brokers, claim handlers, underwriters and legal counsel. Willingess to seek input from others as needed to achieve the best result possible for the client and AXA XL. Communication: Excellent verbal and written communication, presentation and influencing skills. Ability to communicate effectively with internal and external stakeholders to make sure we provide the highest level of customer service. Ethics: Handle responsibilities with integrity and to the highest standards of professionalism. Continuous Improvement Focused: Willing to ask questions and explore new ideas. Eager to learn and ability to focus on continuously improving technical skills and AXA XL claims capabilities. Client-Service Oriented: Focus on value at all points in the claims experience, delivering on our promise to our clients. Who WE are AXA XL, the P&C and specialty risk division of AXA, is known for solving complex risks. For mid-sized companies, multinationals and even some inspirational individuals we don't just provide re/insurance, we reinvent it. How? By combining a comprehensive and efficient capital platform, data-driven insights, leading technology, and the best talent in an agile and inclusive workspace, empowered to deliver top client service across all our lines of business − property, casualty, professional, financial lines and specialty. With an innovative and flexible approach to risk solutions, we partner with those who move the world forward. Learn more at axaxl. com What we OFFER Inclusion AXA XL is committed to equal employment opportunity and will consider applicants regardless of gender, sexual orientation, age, ethnicity and origins, marital status, religion, disability, or any other protected characteristic. At AXA XL, we know that an inclusive culture and enables business growth and is critical to our success. That's why we have made a strategic commitment to attract, develop, advance and retain the most inclusive workforce possible, and create a culture where everyone can bring their full selves to work and reach their highest potential. It's about helping one another - and our business - to move forward and succeed. Five Business Resource Groups focused on gender, LGBTQ+, ethnicity and origins, disability and inclusion with 20 Chapters around the globe. Robust support for Flexible Working Arrangements Enhanced family-friendly leave benefits Named to the Diversity Best Practices Index Signatory to the UK Women in Finance Charter Learn more at Inclusion & Diversity at AXA XL | AXA XL. AXA XL is an Equal Opportunity Employer. Total Rewards AXA XL's Reward program is designed to take care of what matters most to you, covering the full picture of your health, wellbeing, lifestyle and financial security. It provides competitive compensation and personalized, inclusive benefits that evolve as you do. We're committed to rewarding your contribution for the long term, so you can be your best self today and look forward to the future with confidence. Sustainability At AXA XL, Sustainability is integral to our business strategy. In an ever-changing world, AXA XL protects what matters most for our clients and communities. We know that sustainability is at the root of a more resilient future. Our 2023-26 Sustainability strategy, called "Roots of resilience", focuses on protecting natural ecosystems, addressing climate change, and embedding sustainable practices across our operations. Our Pillars: Valuing nature: How we impact nature affects how nature impacts us. Resilient ecosystems - the foundation of a sustainable planet and society - are essential to our future. We're committed to protecting and restoring nature - from mangrove forests to the bees in our backyard - by increasing biodiversity awareness and inspiring clients and colleagues to put nature at the heart of their plans. Addressing climate change: The effects of a changing climate are far-reaching and significant. Unpredictable weather, increasing temperatures, and rising sea levels cause both social inequalities and environmental disruption. We're building a net zero strategy, developing insurance products and services, and mobilizing to advance thought leadership and investment in societal-led solutions. Integrating ESG: All companies have a role to play in building a more resilient future. Incorporating ESG considerations into our internal processes and practices builds resilience from the roots of our business. We're training our colleagues, engaging our external partners, and evolving our sustainability governance and reporting. AXA Hearts in Action: We have established volunteering and charitable giving programs to help colleagues support causes that matter most to them, known as AXA XL's "Hearts in Action" programs. These include our Matching Gifts program, Volunteering Leave, and our annual volunteering day - the Global Day of Giving. For more information, please see Sustainability at AXA XL. The U. S. base salary range for the Claims specialist position is 92,500-138,500 USD and for the Senior Claims Specialist is: 115,500-173,500 USD. Actual pay will be determined based upon the individual's skills, experience and location. We strive for market alignment and internal equity with our colleagues' pay. At AXA XL, we know how important physical, mental, and financial health are to our employees, which is why we are proud to offer benefits such as a competitive retirement savings plan, health and wellness programs, and many other benefits. We also believe in fostering our colleagues' development and offer a wide range of learning opportunities for colleagues to hone their professional skills and to position themselves for the next step of their careers. For more details about AXA XL's benefits offerings, please visit US Benefits at a Glance 2025.

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

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

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-AR1 #Li-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Job Description The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes. DUTIES AND KEY RESPONSIBILITIES: Claims Management and Oversight Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution. Respond to inquiries and concerns regarding new and existing claims Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported. Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution. Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions. Compliance and Reporting Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards. Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes. Monitor claim trends and identify risk mitigation opportunities. Financial Coordination and Invoicing Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting. Support the finance team with forecasting and financial planning related to insurance claims and associated expenses. Work with finance team to place and monitor appropriate reserves and allocate funds. Data Analytics and Reporting Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies. Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders. Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives. Collaboration and Communication Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk. Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters. Provide regular updates to management on claims status, strategic initiatives, and risk trends. Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies. Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management. QUALIFICATIONS: 3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry. Associate's degree required. Excellent customer service skills Strong analytical and problem-solving skills to investigate and diagnose claim driven issues Aptitude to investigate complaints for facts and recommend resolutions in a timely manner Exceptional interpersonal, verbal, and written communication skills Proven customer relationship and conflict resolution skills Ability to develop and maintain strong working relationships with internal and external parties Strong attention to detail and accuracy in data entry and record keeping Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.

We are seeking a Claims Analyst for a well-known insurance company in the White Plains area. The ideal candidate will have hands-on Disability and Paid Family Leave (PFL) claims experience and 1-2 years of billing, coding, or claims experience. This role focuses on reviewing, adjudicating, and processing health insurance claims with a strong emphasis on disability and PFL leaves, ensuring compliance with NYS regulations and company procedures. Key Responsibilities: Assist with incoming Disability, PFL, Critical Illness, and Accident claims, ensuring timely acknowledgment and processing. Determine the correct product and fund (DBL, self-funded, voluntary, PFL, Critical Illness, Accident) and verify eligibility. Apply knowledge of NYS DBL/PFL guidelines, self-funded plans, and voluntary policies to handle claims accurately. Make precise claim determinations, including disability/PFL periods, maximum periods, and other criteria for payment or denial. Requirements: Hands-on experience with Disability and Paid Family Leave claims is required. Basic proficiency in Microsoft Word and Excel. Overview of Role: This role involves reviewing and processing health insurance claims with a focus on Disability and PFL leaves. You will ensure claims meet all regulatory and company standards, investigate complex issues like coordination of benefits or pre-existing conditions, and communicate with claimants, employers, or healthcare providers as needed. Accurate record-keeping and clear member communications are key to success.

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $55,200.00 - $91,100.00 Target Openings 4 What Is the Opportunity? This role is eligible for a sign on bonus up to $10,000 Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner. In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process. What Will You Do? * Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations. * Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates. * Determine claim eligibility, coverage, liability, and settlement amounts. * Ensure accurate and complete documentation of claim files and transactions. * Identify and escalate potential fraud or complex claims for further investigation. * Coordinate with internal teams such as investigators, legal, and customer service, as needed. * Insurance License: In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. What Will Our Ideal Candidate Have? * Bachelor's Degree. * Three years of experience in insurance claims, preferably Auto claims. * Experience with claims management and software systems. * Strong understanding of insurance principles, terminology with the ability to understand and articulate policies. * Strong analytical and problem-solving skills. * Proven ability to handle complex claims and negotiate settlements. * Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. What is a Must Have? * High School Diploma or GED required. * A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is required. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

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

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific accounts(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols. Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim. Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes. Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation. Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities Developing basic knowledge of the commercial insurance industry, products and claim practices. Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service. Ability to develop collaborative business relationships with both internal and external work partners. Able to exercise independent judgement, solve basic problems and make sound business decisions. Analytical mindset with critical thinking skills. Strong work ethic, with demonstrated time management and organizational skills. Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. Knowledge of Microsoft Office Suite and ability to learn business-related software. Adaptable to a changing environment Ability to value diverse opinions and ideas Education & Experience: High school Diploma required. Associates or Bachelor's Degree preferred. Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. Prior claim handling, or business experience in the insurance industry and/or customer service is preferred. #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, t he national base pay range for this job level is $47,000 to $78,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Job Category: Administrative & Clerical Work Shift/Schedule: 8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities. Under the supervision of the Utilization Review Manager, this position is responsible for ensuring the delivery of outstanding customer service in the process of obtaining pre-certification approvals from insurance companies (for both inpatients and outpatients), identifying insurance and/or patient responsibility, insurance verification, admission notifications, identifying approved days, follow up required, and providing financial counseling when appropriate. Minimum Job Qualifications Licensure or other certifications: AAPC or AHIMA certification accepted Educational Requirements: High School Diploma or GED Minimum Experience: In lieu of CPC certification, will accept 5 years direct pre-certification experience. Other: Preferred Job Qualifications Preferred Licensure or other certifications: CPC Certification Preferred Educational Requirements: Preferred Experience: One (1) year of direct pre-certification experience preferred with CPC certification. Other: Knowledge, Skills and Abilities Ability to work independently, emotionally mature, and able to function effectively under stress Excellent problem solving and analytical skills Excellent written and oral communication skills Ability to prioritize, organize, and coordinate daily work load Working knowledge of Protected Health Information Ability to manage change Extensive knowledge of medical terminology Must possess detailed understanding and knowledge of insurance guideline and protocols, the components of full verification, and payer information / requirements Essential Tasks and Responsibilities Responsible for ensuring all scheduled and non-scheduled inpatient and outpatient accounts are pre-authorized either in advance or on the day of the notification of admission (following guidelines set forth by the organization and payers). Provides and interprets clinical information submitted from the Physician, emphasizing the medical justification for a procedure, in order for completion of the pre-certification process. Works in conjunction with Physician offices, Case Management, Utilization Review, and patients to obtain supporting clinical data for the payer in order to obtain a pre-authorization. Obtains complete and accurate insurance information and completes verification of the patient's eligibility for both inpatient and outpatient hospital visits. Acts as liaison and point of contact for/between clinical staff, ancillary departments, patients, referring Physician's office, and insurance payers to inform of authorization delays/denials. Collaborates with Utilization Review nurses to ensure authorization for services is obtained and fully documented in the patient account. Ensures thorough documentation in the patient account of verification and authorization activities. Communicates with Physician office and payer to initiate and mediate Physician to Physician reviews. Understands and retains knowledge of payer requirements in relation to procedure vs. plan type and demonstrates the ability to make informed decisions as to when a pre-authorization is needed. Responsible for the accurate and timely documentation of the pre-certification into the appropriate account. Collaborates with the appeals department to provide all related information to overturn denied claims. Helps monitor insurance authorization issues to identify trends and participates in process improvement initiatives. Expected to answer, manage, and satisfy the customer during all incoming calls as appropriate to their specialty, and to meet department assigned goals relating to outbound calls, average speed to answer, max delays, AUX times, abandonment rate, and ACD time. In addition, expected to meet all customer service standards as set forth by the NGHS STARS standards. Performs any and all related job duties as assigned; may have additional department specific duties assigned as deemed necessary by management. Expected to meet all goals set by department management to include, but not limited to; productivity, accuracy, collections, and customer satisfaction. Physical Demands Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time Weight Carried: Up to 20 lbs, Occasionally 0-30% of time Vision: Moderate, Constantly 66-100% of time Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Occasionally 0-30% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Occasionally 0-30% Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

approved under NYS HELP Program. The NYS Civil Service Commission approved these titles as part of the "HELP" program. Approval is for a period of one year effective 5/24/2023. During this period, employees may be appointed on a non-competitive basis. All non-competitive appointees must meet the minimum qualifications for the positions. Applications will be reviewed and approved by Civil Service. *Candidates will not be required to take traditional civil service exams to attain permanent positions. JOB DESCRIPTION: Review, investigate, evaluate documents and determine eligibility of applications for Temporary Assistance and programs such as SNAP, Medicaid, Child Care and HEAP; Interview applicants and recipients and, as needed, collateral contacts for documentation of eligibility; Evaluates and determines applicant's eligibility for assistance based on an assessment of resources and indicated or identified needs. Prepares and computes budget for the applicants. Advises applicant of his/her rights and responsibilities under the Social Services Law, and makes referrals to other Social Services where need is indicated and/or identified. ** These duties may be performed at one of the Social Services office locations: Hauppauge, Deer Park, Ronkonkoma, Coram or Riverhead** Starting Salary: $41,525 MINIMUM QUALIFICATIONS OPEN COMPETITIVE EITHER: a) Graduation from a standard senior high school or possession of a high school equivalency diploma, and two (2) years of experience in examining, investigating or evaluating claims for assistance, veterans' or unemployment benefits, insurance or a similar program operating under established criteria for eligibility; or , b) Graduation from a standard senior high school or possession of a high school equivalency diploma and two (2) years of experience in a NYS public social services agency performing duties that require substantial client contact for the purpose of implementing, assessing or directly providing agency programs and services. NOTE : Additional education from a college with federally-authorized accreditation or registration by NY State will be substituted for experience on a year-for-year basis. NECESSARY SPECIAL REQUIREMENT(S) At the time of appointment and during employment in this title, employees will be required to possess a valid license to operate a motor vehicle in New York State. For the spanish speaking role ONLY, there will be a qualifying Spanish language examination for Open-Competitive candidates. Suffolk County's Commitment to Diversity, Inclusion & Equity: Our focus is to promote, support, and implement the County-wide diversity and inclusion strategic plan. We achieve results in all our responsibilities through the use of diversity and inclusion best practices. We maintain a familiarity with Diversity & Inclusion trends and best practices. Suffolk County is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.

Liberty Mutual has an immediate opening for a Complex Claims Specialist with Managed Care, Errors & Omissions (E&O) and Directors & Officers (D&O) Professional Liability claims experience. The Complex Claims Specialist, with minimal supervision, handles a book of specialty lines claims under E&O and D&O policies issued to health plans and other Managed Care Organizations throughout the entire claim's life cycle. In this role, you will be responsible for conducting investigations, evaluating coverage, setting adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business. *This position may have an in-office requirement and other travel needs depending on candidate location. If you reside within 50 miles of one of the following offices, you will be required to go to the office twice a month: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; Westborough, MA; or Weatogue, CT. Please note this policy is subject to change. Responsibilities Analyzes, investigates and evaluates the loss to determine coverage and claim disposition. Utilizes proprietary claims management system to document claims and to diary future events or follow up. Issue detailed coverage position letters for all new claims within prescribed time frames. Within prescribed settlement authority, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level. Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting. Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. Pro-actively manages the case resolution process. Actively participates in mediations and arbitrations, as well as negotiation discussions within limit of settlement authority. Participates in the claims audit process. Provides claims marketing services by meeting with brokers and insureds. As required, maintains insurance adjuster licenses Qualifications Bachelors' and/or advanced degree 7 + years claims/legal experience, with at least 2 years within a technical specialty preferred (Managed Care, Errors & Omissions and Directors & Officers) Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge Functional knowledge of law and insurance regulations in various jurisdictions Demonstrated advanced verbal and written communications skills Demonstrated advanced analytical, decision making and negotiation skills About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.