Claims Specialist
Claim processor job in Plano, TX
Duration:6 Months+
Roles & Responsibilities
Maximize customer satisfaction by providing prompt actions to customer's need and obtain quality photos/data to determine root cause of claim to defend or accommodate customer's claim
Provide efficient solutions to customer-facing agents by developing and operating guide and contents
Use various tools/dashboard/systems to quantify the agent's performance of customer care and develop appropriate actions to improve performance and quality
Spanish speaking agent recommended but not a requirement.
[Customer Experience Management] Analyze end-to-end processes that customers experience and participate in providing suitable resolutions accordingly and in controlled & monitored turnaround time for each action of customer claim process
[Quality Management] Monitor and review customer calls/tickets for customer care quality control, carry out activities to secure quality competitiveness of our company and customers
Maintains and improves operational quality by monitoring system performance; identifying and resolving problems; preparing and completing action plans.
Qualifications & Experience
College Graduate
3~5 Years in customer experience
Case management for MX/CE claims
CE Tender management
Pending Management (KPI, LTP)
Case Tracker Management for special issue
CPSC claim management (Customer care/tracker) (CE)
Monitoring FCCM report quality (ACQ/OS Reports)
Special Projects
Customer Care Resolution
EnR Submission/Management
Work to de-escalate customer situations while finding an appropriate solution; involve upper management as needed
Skills
Customer Care Experience (Call Center)
Claims Management Experience
Insurance Claims or Adjuster background beneficial
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details:
Name: P Praveen Chary
Email: ****************************
Internal Id: 25-54476
Legal Claims Analyst
Claim processor job in Plano, TX
ERISA Recovery are experts in collecting complex and aged claims through the Federal ERISA appeals process. We are a fast-growing organization located in Plano, TX. If you would like to join a friendly, passionate team with limitless potential, we'd love to meet you. This extraordinary opportunity to advance your career and make a difference is now.
We are searching for a Legal Hospital Claims Analyst - someone who works well in a fast-paced setting. In this position, you'll provide support in analyzing comprehensive claims and identifying key metrics. You will be a subject matter expert in legal claims. You must be able to work both independently and as part of a team. Key attributes for the ideal candidate include working with intensity, focus, and being detail oriented.
Essential responsibilities and duties
Conducts legal research and investigation of claims
Drafting legal documents
Keeping track of changes in legal framework and providing timely updates on these changes
Utilizes ERISA law enforcement
Utilizes knowledge of health care standards appropriate to specific claim
Ability to understand and apply medical reimbursement policies, procedures, and standards
Ensures eligibility for claims is reasonable and correct by analyzing claims and providing supporting documentation
Utilize a variety of EHR systems
Thrives in a fast-paced environment
Collaborates effectively with other team members
Ability to adapt to changing needs
Consistently applies knowledge relevant to claims
Work intensely at a fast-paced rate
Ability to communicate effectively with third party administrators
Determine the status of medical claims through research
Meet the standards of the department and quality standards
Strong organizational skills
Desired skills and Qualifications
Bachelor's degree
3+ years working in the legal field
2+ years working with healthcare insurance claims (preferred)
Strong Communication skills
Working knowledge utilizing Microsoft software (Word, Excel, Outlook)
Ability to work in a fast-paced environment
Benefits:
401(k)
401(k) matching
Dental insurance
Health insurance
Paid time off
Vision insurance
Paid lunches
Bonus
ERISA Recovery is an Equal Opportunity Employer
Member Claims Examiner
Claim processor job in Plano, TX
At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.
As a Member Claims Examiner, you'll play a critical role in reviewing and resolving complex medical claims issues, leveraging your expertise in medical plan operations to drive accurate and timely claim adjudication. With a focus on delivering exceptional member experiences, you'll utilize your in-depth knowledge of regulatory requirements, network partner relationships, and medical coding to expertly investigate and resolve intricate member issues, ensuring seamless integration of claims processing and member services.
We're seeking an experienced professional to join our team, bringing advanced analytical and problem-solving skills to review and resolve complex medical insurance claims. You'll work closely with our teams to ensure seamless integration of claims processing, member services, and regulatory compliance, driving exceptional results and member satisfaction.
Start Date and Training
Start date: 02/09/2026
You must be available for 4 weeks of required training beginning on the start date through 3/9. You will not be able to take time off during the training period.
What you'll do:
Review and adjudicate complex medical insurance claims, applying industry expertise and knowledge of regulatory requirements
Conduct in-depth investigations and analysis to resolve member issues, ensuring timely and accurate resolutions
Maintain expertise in medical plan operations, including claims processing, network partner relationships, and medical coding
Collaborate with cross-functional teams to identify and implement process improvements, enhancing efficiency and member experience
Provide expert guidance and support to junior team members, sharing knowledge and best practices
To be successful in this role, you'll need:
3+ years of experience reviewing and adjudicating medical insurance claims in a Third-Party Administrator (TPA) or health insurance setting
Proven analytical and problem-solving skills, with ability to navigate complex claims issues
Strong knowledge of medical plan operations, including claims processing, regulatory requirements, and medical coding
Familiarity with medical terminology, anatomy, and physiology to accurately interpret medical records and claims data.
Excellent communication and interpersonal skills, with ability to collaborate with diverse stakeholders
Ability to work in a fast-paced environment, prioritizing multiple tasks and deadlines
Nice To Have:
Bachelor's degree or 5+ years of health insurance customer servicing experience
Experience interpreting and applying plan documents, including Summary Plan Descriptions (SPDs) and other relevant plan documents, to determine claim payment and benefits
Previous experience working with and following regulatory requirements, such as HIPAA, ACA, or other healthcare-related laws and regulations
Possess industry-recognized certifications, such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
Familiarity with the 837 EDI format, with the ability to read, interpret, and apply claims data to resolve complex claims issues.
Pay Transparency Statement
This is a hybrid position based out of our Plano office, with the expectation of being in office at least three weekdays per week. #LI-hybrid
The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at ********************************************
Plano, TX Pay Range$23.70-$29.60 USDWhy Join Us?
Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare
Impactful projects that shape the future of our organization
Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests
Flexible work arrangements and a supportive work-life balance
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com.
Privacy Notice
For more information about why we need your data and how we use it, please see our privacy policy: *********************************************
Auto-ApplyClaims processing
Claim processor job in Plano, TX
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Claims processing to join our team in Plano, Texas (US-TX), United States (US).
Position's General Duties and Tasks
In these roles you will be responsible for:
Review and process insurance claims.
Validate Member, Provider and other Claim's information.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Coordination of Claim Benefits based on the Policy & Procedure.
Maintain productivity goals, quality standards and aging timeframes.
Scrutinizing Medical Claim Documents and settlements.
Organizing and completing tasks per assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
Resolving complex situations following pre-established guidelines
About NTT DATA
NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.
Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client's needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only **************** ******************************* email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, *************************************
NTT DATA endeavors to make ********************** accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at ************************************* This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.
Auto-ApplyWorkers Compensation Claims Specialist, West
Claim processor job in Plano, TX
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).
This position enjoys a flexible, hybrid work schedule and is available in Plano TX, Brea CA, Downers Grove IL or Portland OR CNA office.
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-Hybrid
#LI-KA1
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 ***************************.
Auto-ApplyClaims Processor
Claim processor job in Richardson, TX
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Claims Processor
Type: Temporary/Contract
Length: Up to 90 days (Note: Could be less or could be extended depending on weather events and amount of claims/work to be processed)
Hours: Must be flexible to work 7 days a week: Monday through Friday, 7:00 a.m. to 7:00 p.m.; Saturday and Sunday, 8:00 a.m. to 5:00 p.m.
Pay Rate: $15.00 per hour
Location: Richardson, TX
Qualifications
High school/GED
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Associate Claims Specialist
Claim processor job in Plano, TX
Under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts.
This is a hybrid position. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Westborough, MA; Boston, MA; Suwanee, GA; Hoffman Estates, IL; Plano, TX. Please note this is subject to change.
Responsibilities:
* Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly.
* Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.
* Manages an inventory of property/casualty and disability claims (e.g. workers` compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits.
* Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols.
* Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action.
* Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources.
* Updates files and provides comprehensive reports as required.
* Work on resolution in early life of a claim to avoid attorney representation.
* High volume of incoming claims.
* Time management skills are in need.
Qualifications
* Effective interpersonal, analytical and negotiation abilities required
* Ability to provide information in a clear, concise manner with an appropriate level of detail
* Demonstrated ability to build and maintain effective relationships
* Demonstrated success in a professional environment; success in a customer service/retail environment preferred
* Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
* Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
* Licensing may be required in some states
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
Auto-ApplyClaims Specialist - Auto
Claim processor job in Plano, TX
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a Claims Specialist - Auto to join our team.
JOB SUMMARY
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
Communicates with all relevant parties and documents communication as well as results of investigation.
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
Travel is required to attend customer service calls, mediations, and other legal proceedings.
JOB REQUIREMENTS
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
• National Range : $82,800.00 - $97,300.00
• Ultimate salary offered will be based on factors such as applicant experience and geographic location.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
Auto-ApplyClaims Specialist
Claim processor job in Addison, TX
MSIG USA continues to grow!
MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., one of the world's top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business's unique risks.
Summary/Job Purpose:
This position is responsible to conduct thorough investigations and evaluate and negotiate complex claims including litigation and coverage issues. Accountable to ensure compliance with MSMM Claim Handling Guidelines, including reserving and payment practices, regulatory requirements and Fair Claims Practices Acts.
Essential Functions:
Investigates, researches and analyzes highly complex or severe claims, including coverage issues and legal issues affecting liability and damages.
Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority.
Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claim practices and company policy and procedures.
Attends pre-trials, trials, settlement conferences and mediations on assigned cases as required
Assigns the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the company's Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.
Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews.
Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations.
Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement.
Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations.
Maintains full compliance with all state licensing and continuing education requirements to ensure current and appropriate filing/standing of all adjuster licenses.
Maintains regular reporting of case status, developments and direction to Home Office staff and other appropriate parties as necessary. Ensures timely and appropriate file reports and system documentation as required by company claim manuals and procedures.
Participates and/or manages special projects and assignments as needed.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience Required:
High School Degree or G.E.D. is required. Bachelor's degree preferred
7+ years related experience handling complex Liability or Workers' Compensation Claims
It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!
It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.
Auto Claims Specialist
Claim processor job in Plano, TX
Who are we:
Toyota Insurance is a brand name of Toyota Insurance Management Solutions USA, LLC (TIMS). We are an independent agency specializing in property and casualty insurance for Toyota vehicle owners. We offer insurance through our trusted carrier partners to provide coverage for your Toyota vehicle, home and other assets. Our mission is to improve the Toyota ownership experience by improving the insurance experience.
Job Overview:
We are seeking a detail-oriented and proactive Auto Claims Specialist to join our team and support the auto property damage claims process. This role combines technical expertise in auto damage assessment with advocacy and coordination between internal and external stakeholders to ensure timely, accurate, and fair resolution. The ideal candidate will possess strong analytical skills, attention to detail, and excellent communication abilities with the desire to grow within the claims and insurance operations field.
Job Responsibilities:
Claims Intake & Documentation:
Receive initial auto claim and damage information from internal teams or external parties.
Collect, review, and validate all relevant supporting documentation such as police reports, First Notice of Loss (FNOL), recorded statements, and any other applicable claims information for accuracy and completeness.
Accurately enter claims and damage data into the claims management system (Nexure).
Must have a solid understanding of rideshare insurance policies, including how coverage exclusions apply and impact claims.
File Management & Reporting:
Organize and maintain secure auto claim files and records in compliance with company and regulatory standards.
Submit loss notices and report claims promptly to insurance carriers.
Prepare and submit any additional applicable claims or inquiries as required.
Damage Review & Estimation:
Review and document auto damages thoroughly.
Analyze and validate repair estimates for vehicle damages.
Coordinate with repair shops to discuss damages and confirm accuracy of estimates.
Repair Process Oversight:
Examine and evaluate repair processes and timelines.
Monitor repairs through completion, ensuring quality and adherence to agreed timelines.
Communication & Collaboration:
Serve as the primary liaison between internal departments, vendors, external stakeholders, attorneys, and carriers.
Provide clear and timely updates to all parties involved in the claim process.
Claims Evaluation & Escalation:
Review claim settlement recommendations for accuracy and fairness.
Collaborate with senior claims analyst on complex or high-risk claims and escalate as necessary.
Required Education and Experience:
Licensed as an Adjuster in the State of Texas.
3 to 5 years of experience in auto insurance claims, auto claims adjusting, advocacy and/or auto claims estimation.
Strong knowledge of insurance policies, auto repair processes and claims regulations.
Knowledge of and experience in auto claims involving public or livery passenger conveyance policy exclusions and endorsements.
Excellent organizational, time management skills, and communication skills.
Strong understanding of the complete auto claims process, from initial intake to final resolution.
Ability to work independently with minimal supervision.
Preferred Skills:
Strong analytical and problem-solving abilities.
Excellent written and verbal communication skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and claims management systems.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Insurance agency, brokerage, or agent knowledge and/or experience is a plus.
Strong attention to detail and organizational skills.
Core Competencies:
Analytical Thinking: Ability to interpret complex data, identify trends, and make informed decisions to resolve claims efficiently.
Attention to Detail: Ensures accuracy in documentation, compliance with regulatory requirements, and thorough investigation of claims.
Problem-Solving: Skilled in evaluating claim scenarios and developing effective solutions to minimize risk and optimize outcomes.
Communication Skills: Strong written and verbal communication for interacting with internal teams, external partners, and clients.
Work Environment and Physical Demands:
Ability to work within a Team environment under tight schedules.
Willingness to work evenings or weekends, as dictated by the needs of the business.
Compensation:
Base Salary: $46,000-$60,000 based on skills and experience
Onsite-Plano office
What are the Perks?
Medical, Dental & Vision Insurance
Paid Time Off, Paid Holidays and Sick Days
401(k) Match
FSA and HSA
Pet Insurance
Life Insurance
Degree of Travel:
None
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Work Authorization:
Applicants must be authorized to work for any employer in the U.S. This position does not offer sponsorship or the transfer of sponsorship of employment Visa.
Learn More:
Visit our website Toyota Insurance: *********************************** to learn more about our company culture and career opportunities.
FLSA Job Status: ☒ Exempt ☐Non-Exempt
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
An Equal Opportunity Employer: Female / Minority / Disability / Protected Veteran / Sexual Orientation / Gender Identity
EEOC is The Law' Information:
******************************************************************************
Claims Settlement Specialist
Claim processor job in Plano, TX
For More Open Positions Visit us at:
**********************************
Our Mission WOONGJIN, Inc. is a rapidly growing team who provides a range of unique, exceptional, and enhanced services to our clients. We have a strong moral code that includes the service of goodness without expectations of reward. We are motivated by the sense of responsibility and servant leadership.
Benefits
Medical Insurance
Vision Insurance
Dental Insurance
401(k)
Paid Sick hours
Job Description
Process carrier claim payments (AR) accurately on or before deadlines according to company policy.
Collaborate with our Recovery Team to report claim approvals and pending payments.
Review essential claim documentation to confirm payment accuracy (AP).
Communicate with carriers/3PL's to confirm payment details.
Audit/Manage contracts and tariffs in regards to process payments in the system.
Dispute invalid claim resolutions to overturn declination and negotiate claim settlements
Investigate and diagnose potential errors preventing payment processing
Facilitate Legal reviews to review and execute settlement agreements from carriers/3PL's.
Work within company guidelines to analyze contractual agreements of the customer, shipper, consignee or carrier and then assess the physical damage reports and the cargo claims findings
Track and submit approval requests for aging claim offsets against carrier invoices.
Perform ad-hoc reporting or other job-related duties, as required
Contract period: 3 months + Extend
Salary: $24 - $26/hr.
Qualifications
Required proficiency in Microsoft Excel, including but not limited to, advanced reporting functions and formatting, VLOOKUP, and pivot tables
3-5 years of Accounting/Finance experience preferred
1+ years of freight claims processing
Excellent verbal and written communication skills
Strong critical thinking and creative problem solving skills
Flexibility to work in a fast-paced, team-oriented environment
Superior attention to detail, organization, cross-group collaboration, and project management skills
Additional Information
All your information will be kept confidential according to EEO guidelines.
*** NO C2C ***
Global Risk Solutions Claims Specialist Development Program (January, June 2026)
Claim processor job in Plano, TX
Claims Specialist Program
Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance!
Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes.
The details
When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault.
You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case.
You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual.
Qualifications
What you've got
You have 0-2 years of professional experience.
A strong academic record with a cumulative 3.0 GPA preferred
You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism.
You possess strong negotiation and analytical skills.
You are detail-oriented and thrive in a fast-paced work environment.
You must have permanent work authorization in the United States.
What we offer
Competitive compensation package
Pension and 401(k) savings plans
Comprehensive health and wellness plans
Dental, Vision, and Disability insurance
Flexible work arrangements
Individualized career mobility and development plans
Tuition reimbursement
Employee Resource Groups
Paid leave; maternity and paternity leaves
Commuter benefits, employee discounts, and more
Learn more about benefits at **************************
A little about us
As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow.
We were recognized as a ‘2018 Great Place to Work' by Great Place to Work US, and were named by
Forbes
as one of the best employers in the country for new graduates and women-as well as for diversity.
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.
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Auto-ApplyAuto Liability PD Claims Specialist
Claim processor job in Richardson, TX
Job Description
Imagine being part of a fun and energetic environment where your problem-solving skills are not only valued but celebrated. You will work onsite alongside like-minded professionals, fostering a culture of collaboration and high performance. Embrace your potential in a forward-thinking atmosphere dedicated to customer-centricity and integrity, ensuring every claim is handled with empathy and expertise.
If you thrive in an environment that motivates you to think abundantly and push the boundaries of what's possible, then this is the role for you. You can get great benefits such as Medical, Dental, Vision, 401(k), Life Insurance, Health Savings Account, Flexible Spending Account. Commitment to Training & Development, Competitive Salary, and Paid Time Off. Don't miss out on the chance to make a meaningful impact-apply today!
What's your day like?
As an Auto Liability PD Claims Specialist at Lonestar, you'll engage in a variety of fulfilling tasks each day. Starting your week on a Monday, you can expect to manage a portfolio of auto liability claims, conducting thorough investigations into incidents while ensuring compliance with industry regulations. Your day will involve reviewing documentation, communicating with policyholders, and collaborating with internal teams to resolve claims efficiently.
You'll expertly analyze loss details, assess damages, and negotiate settlements in a timely manner. Daily interactions will include empathetic communication with customers, guiding them through the claims process, and providing updates on their cases. Your work schedule will be Monday through Friday, from either 8:00 AM to 5:00 PM or 8:30 AM to 5:30 PM, allowing for a balanced work-life harmony as you contribute to our high-performance culture.
Are you the Auto Liability PD Claims Specialist we're looking for?
To thrive as an Auto Liability PD Claims Specialist at Lonestar, you'll need a unique blend of skills and expertise. With a minimum of three years' experience in auto liability and property damage claims, you'll leverage your technical knowledge to effectively determine the course of action on each assigned file. Strong analytical skills are essential for conducting thorough investigations and maintaining accurate documentation of coverage, liability, and applicable damages.
Exceptional communication skills-both verbal and written-will enable you to work seamlessly with internal teams and external customers, ensuring a collaborative approach to establishing facts and developing evidence. Organizational capabilities will help you prioritize multiple claims, keeping up with current assignments for prompt resolution. A Texas Licensed Adjuster certification is required, and familiarity with unfair claim practices is vital.
Experience in automated claims processing is preferred, and being bilingual in Spanish is a valuable asset in fostering strong customer relationships. Your professionalism will be crucial in handling vendor interactions while maintaining Lonestar's reputation for quality service.
Knowledge and skills required for the position are:
Review and determine course of action on each file assigned
utilizing technical knowledge and experience for the purpose of supporting final disposition of a loss.
Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage liability
status and damages that are applicable for each claim.
Honor/decline/negotiate first and third-party liability claims upon completion of coverage/policy investigation and analysis of damages and liability.
Work directly with internal and external customers to develop evidence and establish facts on assigned claims.
Organize
plan and prioritize work activities to keep up with current assignments and to ensure prompt conclusion of claims.
Prepare and present claim evaluations for the appropriate settlement authority.
Notify the Underwriting Department of any adverse information uncovered in the course of the investigation.
Familiarity with unfair claim practices in states where doing business.
Conduct business with vendors in a professional manner while maintaining a reasonable expense factor and upholding the company's reputation for quality service.
Provide customer service both to internal and external customers.
Handle other duties as assigned.
QUALIFICATIONS REQUIRED:
Minimum of 3 years previous auto liability/PD claims handling experience is required!
Non-Standard insurance experience is preferred but not required.
Texas Licensed Adjuster - All Lines is required (Multi-State licensing is preferred).
Excellent analytical
organizational
interpersonal and communication (verbal and written and phone) skills.
Strong skills in the areas of verbal and written communication with an ability to develop and maintain positive customer experience and management and third-party customer relationships.
Experience in an automated claims processing work environment
Knowledge of fraud reduction practices
General working knowledge of policies
file procedures
state rules and regulations.
Ability to pass written examinations where required by state statutes to become a licensed Claims Adjuster.
Bi-lingual in Spanish is a plus!
In-Office Position (not available for hybrid or remote).
Are you ready for an exciting opportunity?
If you think this job is a fit for what you are looking for, great! We're excited to meet you!
Job Posted by ApplicantPro
Claims processing
Claim processor job in Plano, TX
**Req ID:** 349396 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Claims processing to join our team in Plano, Texas (US-TX), United States (US).
**Position's General Duties and Tasks**
**In these roles you will** **be responsible for:**
+ Review and process insurance claims.
+ Validate Member, Provider and other Claim's information.
+ Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
+ Coordination of Claim Benefits based on the Policy & Procedure.
+ Maintain productivity goals, quality standards and aging timeframes.
+ Scrutinizing Medical Claim Documents and settlements.
+ Organizing and completing tasks per assigned priorities.
+ Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
+ Resolving complex situations following pre-established guidelines
**About NTT DATA**
NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.
Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client's needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only **************** ******************************* email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, ************************************ .
**_NTT DATA endeavors to make_** **_************************* **_accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at_** **_************************************_** **_._** **_This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here (***************************************** . If you'd like more information on your EEO rights under the law, please click here (***************************************************** . For Pay Transparency information, please click here (***************************************** ._**
Easy ApplyClaims Processor
Claim processor job in Richardson, TX
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Claims Processor
Type:
Temporary/Contract
Length:
Up to 90 days (Note: Could be less or could be extended depending on weather events and amount of claims/work to be processed)
Hours:
Must be flexible to work 7 days a week: Monday through Friday, 7:00 a.m. to 7:00 p.m.; Saturday and Sunday, 8:00 a.m. to 5:00 p.m.
Pay Rate:
$15.00 per hour
Location:
Richardson, TX
Qualifications
High school/GED
Additional Information
Kelly Services is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide: www.kellyservices.com.
Associate Claims Specialist
Claim processor job in Plano, TX
Under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts.
This is a hybrid position requiring twice a month in-office with preference on candidates residing within 50 miles of Suwanee, GA office. Please note this is subject to change.
Responsibilities
* Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly.
* Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.
* Manages an inventory of property/casualty and disability claims (e.g. workers` compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits.
* Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols.
* Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action.
* Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources.
* Updates files and provides comprehensive reports as required.
Qualifications
* Effective interpersonal, analytical and negotiation abilities required.
* Ability to provide information in a clear, concise manner with an appropriate level of detail.
* Demonstrated ability to build and maintain effective relationships.
* Demonstrated success in a professional environment; success in a customer service/retail environment preferred.
* Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent.
* Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory.
* Licensing may be required in some states.
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
Auto-ApplyAuto Claims Specialist
Claim processor job in Plano, TX
Who are we:
Toyota Insurance is a brand name of Toyota Insurance Management Solutions USA, LLC (TIMS). We are an independent agency specializing in property and casualty insurance for Toyota vehicle owners. We offer insurance through our trusted carrier partners to provide coverage for your Toyota vehicle, home and other assets. Our mission is to improve the Toyota ownership experience by improving the insurance experience.
Job Overview:
We are seeking a detail-oriented and proactive Auto Claims Specialist to join our team and support the auto property damage claims process. This role combines technical expertise in auto damage assessment with advocacy and coordination between internal and external stakeholders to ensure timely, accurate, and fair resolution. The ideal candidate will possess strong analytical skills, attention to detail, and excellent communication abilities with the desire to grow within the claims and insurance operations field.
Job Responsibilities:
Claims Intake & Documentation:
Receive initial auto claim and damage information from internal teams or external parties.
Collect, review, and validate all relevant supporting documentation such as police reports, First Notice of Loss (FNOL), recorded statements, and any other applicable claims information for accuracy and completeness.
Accurately enter claims and damage data into the claims management system (Nexure).
Must have a solid understanding of rideshare insurance policies, including how coverage exclusions apply and impact claims.
File Management & Reporting:
Organize and maintain secure auto claim files and records in compliance with company and regulatory standards.
Submit loss notices and report claims promptly to insurance carriers.
Prepare and submit any additional applicable claims or inquiries as required.
Damage Review & Estimation:
Review and document auto damages thoroughly.
Analyze and validate repair estimates for vehicle damages.
Coordinate with repair shops to discuss damages and confirm accuracy of estimates.
Repair Process Oversight:
Examine and evaluate repair processes and timelines.
Monitor repairs through completion, ensuring quality and adherence to agreed timelines.
Communication & Collaboration:
Serve as the primary liaison between internal departments, vendors, external stakeholders, attorneys, and carriers.
Provide clear and timely updates to all parties involved in the claim process.
Claims Evaluation & Escalation:
Review claim settlement recommendations for accuracy and fairness.
Collaborate with senior claims analyst on complex or high-risk claims and escalate as necessary.
Required Education and Experience:
Licensed as an Adjuster in the State of Texas.
3 to 5 years of experience in auto insurance claims, auto claims adjusting, advocacy and/or auto claims estimation.
Strong knowledge of insurance policies, auto repair processes and claims regulations.
Knowledge of and experience in auto claims involving public or livery passenger conveyance policy exclusions and endorsements.
Excellent organizational, time management skills, and communication skills.
Strong understanding of the complete auto claims process, from initial intake to final resolution.
Ability to work independently with minimal supervision.
Preferred Skills:
Strong analytical and problem-solving abilities.
Excellent written and verbal communication skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and claims management systems.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Insurance agency, brokerage, or agent knowledge and/or experience is a plus.
Strong attention to detail and organizational skills.
Core Competencies:
Analytical Thinking: Ability to interpret complex data, identify trends, and make informed decisions to resolve claims efficiently.
Attention to Detail: Ensures accuracy in documentation, compliance with regulatory requirements, and thorough investigation of claims.
Problem-Solving: Skilled in evaluating claim scenarios and developing effective solutions to minimize risk and optimize outcomes.
Communication Skills: Strong written and verbal communication for interacting with internal teams, external partners, and clients.
Work Environment and Physical Demands:
Ability to work within a Team environment under tight schedules.
Willingness to work evenings or weekends, as dictated by the needs of the business.
Compensation:
Base Salary: $46,000-$60,000based on skills and experience
Onsite-Plano office
What are the Perks?
Medical, Dental & Vision Insurance
Paid Time Off, Paid Holidays and Sick Days
401(k) Match
FSA and HSA
Pet Insurance
Life Insurance
Degree of Travel:
None
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Work Authorization:
Applicants must be authorized to work for any employer in the U.S. This position does not offer sponsorship or the transfer of sponsorship of employment Visa.
Learn More:
Visit our website Toyota Insurance:************************************* learn more about our company culture and career opportunities.
FLSA Job Status: Exempt Non-Exempt
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
An Equal Opportunity Employer: Female / Minority / Disability / Protected Veteran / Sexual Orientation / Gender Identity
EEOC is The Law' Information:
******************************************************************************
US Retail Markets Claims Specialist Development Program-(January, June 2026)
Claim processor job in Plano, TX
Description Advance your career at Liberty Mutual - A Fortune 100 Company! Manages, investigates and resolves claims assigned and assists in providing service to policyholders. Responsibilities:
Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.
Ensures adequacy of reserves.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or co-defendants. Arranges for expert inspections involving third party or potential fraud actions as needed.
Updates files and provides comprehensive reports as required
Qualifications Qualifications:
Strong written and oral communications skills required.
Good interpersonal, analytical, investigative, and negotiation skills required.
Customer service experience preferred.
Basic knowledge of legal liability, general insurance policy coverage and State Tort Law.
Bachelor's degree is required.
Ability to obtain proper licensing as required.
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Auto-ApplyClaims Examiner
Claim processor job in Plano, TX
NTT Data Services is Hiring! **Grade 3 - HC & Insurance Operations Sr Rep** At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring, the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
NTT DATA, Inc. currently seeks an "BPO HC & Insurance Operations Sr Rep
**Client's business problem to solve?**
Our Client is one of Leading Health Plan in US providing services in Florida state, NTT are getting into contract with Client to manage End to End Claims Administration services. Our NTT Business Process Outsourcing (BPO) team has implemented the processes and technologies for our clients bring about real transformation for customers of all sizes. Our end-to-end administrative services help streamline operations, improve productivity and strengthen cash flow to help our customers stay competitive and improve member satisfaction
**Position's General Duties and Tasks**
**In these roles you will be responsible for:**
+ Review and process insurance claims.
+ Validate Member, Provider and other Claim's information.
+ Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
+ Coordination of Claim Benefits based on the Policy & Procedure.
+ Maintain productivity goals, quality standards and aging timeframes.
+ Scrutinizing Medical Claim Documents and settlements.
+ Organizing and completing tasks per assigned priorities.
+ Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
+ Resolving complex situations following pre-established guidelines
**Requirements for this role include:**
+ University degree or equivalent that required formal studies of the English language and basic Math
+ 6+ months of experience where you had to apply business rules to varying fact situations and make appropriate decisions
+ 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
+ 6+ months of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
+ 6+ months of experience that required prioritizing your workload to meet deadlines
**Preferences:** - Optional (nice-to-have's)
+ Ability to communicate (oral/written) effectively to exchange information with our client.
+ Commerce graduate with English as a compulsory subject
Required schedule availability for this position is Monday-Friday . The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.
Global Risk Solutions Claims Specialist Development Program (January, June 2026)
Claim processor job in Plano, TX
Claims Specialist Program Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance! Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes.
The details
When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault.
You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case.
You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual.
Qualifications
What you've got
* You have 0-2 years of professional experience.
* A strong academic record with a cumulative 3.0 GPA preferred
* You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism.
* You possess strong negotiation and analytical skills.
* You are detail-oriented and thrive in a fast-paced work environment.
* You must have permanent work authorization in the United States.
What we offer
* Competitive compensation package
* Pension and 401(k) savings plans
* Comprehensive health and wellness plans
* Dental, Vision, and Disability insurance
* Flexible work arrangements
* Individualized career mobility and development plans
* Tuition reimbursement
* Employee Resource Groups
* Paid leave; maternity and paternity leaves
* Commuter benefits, employee discounts, and more
Learn more about benefits at **************************
A little about us
As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow.
We were recognized as a '2018 Great Place to Work' by Great Place to Work US, and were named by Forbes as one of the best employers in the country for new graduates and women-as well as for diversity.
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.
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
Auto-Apply