Claim processor jobs in South Portland, ME - 161 jobs

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include: Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations. Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies. Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic. Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning. Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives. Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support. Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations. Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery. Continue developing technical, analytical, and consulting skills while building credibility with clients. Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement. Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team. What You Bring Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred. Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles. Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance. Epic Resolute or other hospital billing system experience preferred; Epic certification a plus. Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required. Additional certifications such as CHC, CFE, or AHFI preferred. Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization. Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred. Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act. Willingness to travel up to 25%, based on client and project needs. How You'll Thrive Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions. Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships. Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time. Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment. Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility. Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.

At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: * Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs * Consistently adhere to the documented workflow guidelines and established procedures. * Maintain required levels of confidentiality * Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education * Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines * Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations * Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures * Assist in the subrogation process to recover money from third parties * Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD * Document claim file actions and telephone conversations appropriately * Refer claim activity outside authority level to Supervisor/Manager for review * Proactively communicate with claimants, policyholders and physicians to resolve investigations issues * Establish, communicate and manage claimant and policyholder expectations * Utilize most efficient means to obtain claim information * Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations * Respond to customer service issues within required timeframes * Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures * Support relationships with technical resources to achieve appropriate outcomes * Meet or exceed departmental service, quality and production objectives * Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies * All other duties as assigned REQUIREMENTS: * BA/BS or equivalent combination of education and experience * 0-2+ years of experience in managing Short Term Disability claims with first pay authority * Ability to fluently speak and write Spanish a plus * Excellent customer service skills * Excellent math and calculation skills * Good decision-making skills * Ability to analyze complex claim information * Working knowledge of Microsoft Excel and Word * High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

Job Responsibilities and Requirements The Claims Examiner will act as a liaison between client, employee and healthcare provider. In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients. Description of responsibilities: Investigates claim issues providing resolution within departmental and regulatory guidelines. Interprets and administers contract provisions: eligibility and duration Accurately codes all system fields with correct financial, diagnosis and duration information. Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work. Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations. Makes determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management. Determines the duration associated with the leave and or disability based on the information given by the healthcare provider. Process medium to high complexity or technically difficult claims. Develops and manages claims thought well developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. Actively contributes to customer service, quality and performance objectives. Proactively engages in departmental training to remain current with all claim management practices. Responsible for managing Performance Guarantee clients and meet targeted metrics. Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations. Qualifications: High School Diploma or GED (Bachelor's preferred) Ability to develop proficiency regarding required RSL products, systems and processes related to the effective delivery of new business proposals Microsoft Office experience Attention to detail, analytical skills, and the ability to collaborate with others and work independently Strong organizational skills, including the ability to prioritize work and multi-task Customer service experience and orientation Written and verbal communication skills. The expected hiring range for this position is $23.24 - $29.04 hourly for work performed in the primary location (South Portland, ME). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for all team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection when you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off - new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service. Volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program Our Values: Integrity Empowerment Compassion Collaboration Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Hybrid #LI-MR1

Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs. Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district. Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more! Qualifications We are located in Boston, but you can work from your home in this telecommuting position. You will be responsible for the fair and accurate disposition of the Company's most complex casualty claims through investigation, evaluation, and settlement or recommendation within the authority level granted by the Territorial Claim Manager. Duties Interprets and determines policy coverages under the personal lines and commercial lines classifications Investigates, analyzes, and evaluates liability and damages Develops and maintains case files that document all actions Establishes adequate and timely reserves in accordance with company guidelines Provides equitable evaluations and settlements through negotiations Directs and monitors defense counsel in the handling of cases in litigation, through conclusion by trial or settlement Identifies, investigates, and refers potential fraudulent claims to SIU Answers questions and resolves problems within established levels of authority Provides excellent customer service Assists in training and provides a resource to adjusters Performs other activities as required Qualifications College degree or commensurate casualty claims experience required 5+ years of experience handling MA auto bodily injury claims required Significant mediation and litigation experience required

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs Consistently adhere to the documented workflow guidelines and established procedures. Maintain required levels of confidentiality Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures Assist in the subrogation process to recover money from third parties Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD Document claim file actions and telephone conversations appropriately Refer claim activity outside authority level to Supervisor/Manager for review Proactively communicate with claimants, policyholders and physicians to resolve investigations issues Establish, communicate and manage claimant and policyholder expectations Utilize most efficient means to obtain claim information Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations Respond to customer service issues within required timeframes Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures Support relationships with technical resources to achieve appropriate outcomes Meet or exceed departmental service, quality and production objectives Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies All other duties as assigned REQUIREMENTS: BA/BS or equivalent combination of education and experience 0-2+ years of experience in managing Short Term Disability claims with first pay authority Ability to fluently speak and write Spanish a plus Excellent customer service skills Excellent math and calculation skills Good decision-making skills Ability to analyze complex claim information Working knowledge of Microsoft Excel and Word High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

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

Job Description At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs Consistently adhere to the documented workflow guidelines and established procedures. Maintain required levels of confidentiality Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures Assist in the subrogation process to recover money from third parties Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD Document claim file actions and telephone conversations appropriately Refer claim activity outside authority level to Supervisor/Manager for review Proactively communicate with claimants, policyholders and physicians to resolve investigations issues Establish, communicate and manage claimant and policyholder expectations Utilize most efficient means to obtain claim information Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations Respond to customer service issues within required timeframes Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures Support relationships with technical resources to achieve appropriate outcomes Meet or exceed departmental service, quality and production objectives Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies All other duties as assigned REQUIREMENTS: BA/BS or equivalent combination of education and experience 0-2+ years of experience in managing Short Term Disability claims with first pay authority Ability to fluently speak and write Spanish a plus Excellent customer service skills Excellent math and calculation skills Good decision-making skills Ability to analyze complex claim information Working knowledge of Microsoft Excel and Word High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements. What you will do Responsible for reviewing receipt submissions for required information. Outreach to providers, pharmacies, and members to obtain additional information as needed. Reviewing settlement documentation to determine whether a receipt is reimbursable. Keying in the necessary information to create a claim. Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor. Maintain the expected turnaround time for processing receipts. Performing other clerical tasks, as required. Demonstrates a commitment to service by consistent attendance and punctuality. Skills and Abilities Proficient in MS Office. Excellent critical thinking and decision-making skills. Good administrative and organizational skills. Excellent written and verbal communication skills with ability to adapt communication style depending on audience. Meticulous attention to detail. Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation. Ability to work independently and as part of a team. Education Qualifications H.S. Diploma or General Education Degree (GED) required Experience Qualifications 0-2 years experience as a Claims Processor or in a related role required The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation. #LI-BB1 #LI-HYBRID Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* Responsible for supporting both the supervisor and examiners in the day-to-day operation of the claim team. The Claims Team Lead will also be responsible for developing and sustaining excellent internal partnerships with other areas in the company. In addition, the Claims Team Lead will act as an examiner when needed to balance workloads. In this role, they would be accountable for the decision making process for determining eligibility under federal, state laws and client policy. Secure and analyze information to make and approve decisions on all short-term disability, insured or self-insured, and/or statutory claims and their concurrent leave claims. Develop and apply appropriate claim and workflow management strategies, coordinating both disability and leave decisions while meeting timeliness regulations. Duties and Responsibilities: Supports the achievement of established departmental goals and objectives related to all claim operations in compliance with the Claim Organization's standards Supports both the supervisor for team leadership, as well as the individual examiners to provide day-to-day guidance and workload balancing. Partners with Claim Operations leaders to review specific claims that fall within defined parameters to better understand claim trends, training opportunities, coaching opportunities, and/or performance management opportunities. Supports all training and coaching activities through communications via phone, email and video follow-up with examiners/supervisors. Develops and maintains strong working relationships with business partners. Reviews claims to ensure that decisions related to eligibility, disability, offsets, benefit calculations and ongoing claim management are accurate and appropriate. Ensures achievement of specific customer service, quality and production objectives. Ensures claim process consistency through continuous communication and feedback with the examiners/supervisor. Responsible for assisting in reviewing and completing monthly reports Ability to interact and respond to both internal and external customers regarding claim results. Ability to prioritize and manage changing workloads, meeting deadlines independently and through management of others. Ability and knowledge to assist with claim denial reviews. Ability to assist in claim auditing. Completion of Mentor Training and successful completion of one year of mentoring. Collaborates with team members and management in identify and implementing improvement opportunities. Ability to participate in finalist presentations and ongoing client meetings. Ability to review audit findings and prepare rebuttals. Ability to back up supervisor in periods of extended absences or vacations Ability to back up examiners in periods of high volume or extended absences/vacations with the following duties and responsibilities: Responds to customer service issues within required timeframes. Pro-actively communicates decisions within Best Practice guidelines, consistently meeting Performance Guarantee requirements. Determining eligibility under federal and state requirements for leaves submitted and determines eligibility under client's plan/policy. Medical certification review and management supplied by the healthcare provider. Makes determinations to approve, deny or delay and or reach out to additional resources for review. Determining the duration associated with the leave and or disability based on the information given by the healthcare provider. Communicating approvals, denials, leave extensions, return to work plans and other important information regarding the leave to the employee and client. Managing leaves that are concurrent with Short Term Disability and Workers' Compensation. Managing intermittent, continuous and client specific leaves of absences. Processing all leaves within the specific timeframes outlined within Matrix Best Practices guidelines. Facilitate issue resolution and draw on expertise of internal partners as needed. Ability to interpret and administer policy/plan provisions Fully Investigates all relevant issues, providers, payment or denials, promptly and in full compliance with departmental procedures and unfair claims practice and regulations. Manages self-insured business in accordance with client's plans and custom requirements. Basic knowledge of ERISA. Ability to calculate earnings and benefit levels. Document claim file actions and conversations thoroughly. Fully Investigates all relevant issues, providers, payments. Demonstrates ability to independently investigate, evaluate and adjudicate claims of high degree of complexity. Any other job-related duty as deemed appropriate by management REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience Associate's Degree or equivalent required. Bachelor's Degree preferred. Completion of HIAA, LOMA or ICA courses desirable. Minimum of 5 years relevant experience Demonstrated ability to handle multiple competing priorities. Demonstrated ability to provide feedback on Claims handling Demonstrated ability to function with limited supervision. Demonstrated ability to work well in a high visibility environment, with excellent written and verbal communication skills. Ability to Travel: Up to 10% PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: “Occasional”: done only from time to time, but necessary when it is performed “Frequent”: regularly performed; generally an act that is required on a daily basis “Continuous”: typically performed for the majority of an employee's shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES Collaboration Compassion Empowerment Integrity Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $63,540.00 - $85,800.00 annually. This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate's starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important asset-you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for all team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection when you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off - new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service. Volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program Our Values: Integrity Empowerment Compassion Collaboration Fun EEO Statement Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide: * Award-winning culture * Inclusion and diversity as a priority * Performance Based Incentive Plans * Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability * Generous PTO (including paid time to volunteer!) * Up to 9.5% 401(k) employer contribution * Mental health support * Career advancement opportunities * Student loan repayment options * Tuition reimbursement * Flexible work environments * All the benefits listed above are subject to the terms of their individual Plans. And that's just the beginning… With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today! General Summary: Minimum starting hourly rate is $22.60 This is an entry level position within the Voluntary Benefits Claims Organization. This position is responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims in conjunction with providing technical expertise regarding applicable regulations. This position is responsible for providing excellent customer service and interacts on a regular basis with employees, employers, health care providers and other specialized internal resources. Incumbents in this role are considered trainees and are assigned a formal mentor for 6-12 months until they are assessed as capable of independent work. Incumbents are primarily responsible for learning and developing the skills, knowledge, and behaviors necessary to successfully adjudicate assigned claims, in accordance with our claims philosophy and policies and procedures. Incumbent must demonstrate the ability to effectively manage an assigned caseload, exercise discretion and independent judgment, and appropriately render timely claim decisions while demonstrating strong customer service prior to movement to the exempt level claims specialist role. Principal Duties and Responsibilities: * Maintain organizational service standards on all assigned claims demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity. * Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including products, policies, procedures, and contracts. * Develop an understanding of the applicable contract/policy definitions and relevant provisions, clauses, exclusions, riders, and waivers, as well as regulatory and statutory requirements for claim products administered. * Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions, and benefits payee. * Develop problem solving skills by demonstrating analytical and logical thinking resulting in the timely and accurate adjudication of a variety of simple to complex voluntary benefits claims. * Develop a working knowledge of systems needed for claims adjudication. * Provide excellent customer service and independently respond to all inquiries within service guidelines. * Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (i.e., medical assessments, billing, etc.) as appropriate. * Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively communicate determinations while ensuring compliance with Voluntary Benefits procedures and all legal requirements including state regulations. * Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation, when appropriate. * Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business, ensuring a coordinated and continuous claims experience for customers. * Be familiar with specialized workflow requirements and performance standards for any assigned customers. * May perform other duties as assigned. Job Specifications: * 4-year degree preferred or equivalent work experience * Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience * Medical background, voluntary benefits claims and/or disability management experience preferred * Possess strong analytical, critical thinking, and problem-solving skills * Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decision and ongoing medical management. * Able to effectively utilize a broad spectrum of resources, materials, and tools needed to assist with the decision-making process * Strong service and quality orientation. * Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc. * Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness. * Excellent communication skills, written and verbal * Meets the standards for this position, as defined in the Talent Management framework ~IN3 #LI-LM2022 Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $40,000.00-$75,600.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans. Company: Unum

Analyst (Graduate Hire 2026) - Medical Important Dates: * Application Deadline: February 13, 2026 * Start Date Range: August - September 2026 Application & Recruitment Process As part of your application, please submit a cover letter addressing the questions below. Candidates who do not submit a cover letter with responses to these questions will not be considered. Cover Letter Questions: * Why are you interested in Prescient Healthcare Group? What attracted you to this role? * What are your top three attributes that will make you a successful consultant? * How many times have you practiced a case with a peer? * What interests you most about working in the life sciences and pharmaceutical industry, and how have your academic experiences, internships, or other relevant exposure prepared you for this role? Recruitment Timeline: * February 16- February 27: Selected candidates will complete an introductory interview with a member of our Talent Acquisition team * February 27: All candidates will be notified of next steps. * March 4th: Final in-person assessment day (behavioral + case interviews) To ensure availability, candidates are encouraged to tentatively block March 4th for the in-person interview day. About You Do you have a passion for: * Understanding tomorrows emerging therapeutic areas? * Unlocking the full potential of new therapies and shaping successful future therapies? * Understanding why healthcare professionals and patients behave the way they do, and applying this to medical, clinical, and commercial strategies? * Are you a highly motivated professional interested in being part of a new and exciting team, working with global healthcare and pharmaceutical clients across the full product life cycle? About Prescient Healthcare Group (PHG) Our goal is a simple one: we solve exciting, real-world pharma challenges that ultimately make a meaningful difference in patients' lives. PHG is a unique global biopharma, insight-led strategy consultancy. Our core focus is helping biopharmaceutical clients create clinical and commercial strategies that deliver groundbreaking new treatments for patients. With offices in ten major cities across the world, we are a truly global enterprise and are still growing fast, offering our people endless opportunities, supporting rapid personal and professional development. We work with industry leading companies across the full product life cycle, to help them unlock the full potential of their brands. About the Opportunity The role will be varied, giving you the opportunity to develop and hone new skills whilst improving your knowledge of the healthcare industry. You will receive exposure to a broad mix of projects - varied therapeutic areas, a range of client sizes, and domestic vs. global reach. This will enable you to get the experience to decide if you want to take a more specialized route as your career progresses. Our onboarding and training program will provide the support and development you need to hit the ground running; a mix of formal classroom training, shadowing colleagues on projects and 'on the job' coaching will equip you with the capabilities you need to succeed at Prescient. Key Responsibilities: * Exhibit high degrees of professionalism across each aspect of working life, demonstrating respect, integrity and support for colleagues and in our interactions with clients * Take pride in and full responsibility for meeting high levels of performance in work process and output; take charge of own professional development and proactively seek opportunities for growth * Demonstrate a strong willingness to learn and a 'can-do' attitude; showcase ability to gain expert status on a new topic and create an impact within the team and with clients * Demonstrate an ability to thrive in an environment through efficient planning * Demonstrate an ability and willingness to take risks, work in a non-hierarchical environment and take step-up/step-down roles to support strong outcomes * Act as a role model in line with company and client codes of ethics and processes; represent the company and promote its reputation to a high standard Desired Experience and Skills * Bachelors in a relevant field (e.g., Life Sciences, Biotechnology, Neuroscience, Pharmacology, Business, Economics, Marketing, or Psychology). * Demonstrated passion for the life sciences and pharmaceutical industry, supported by academic research, industry exposure, or relevant coursework. * Ability to rapidly synthesize, analyse, and apply new information, demonstrating intellectual agility and a proactive approach to problem-solving. * Exceptional verbal and written communication abilities, with a track record of delivering clear, concise, and impactful presentations and reports. * A drive for self-improvement - the best consultants are those that seek out and action on feedback to improve themselves. * Entrepreneurship - The ability to lead and drive outcomes, particularly in situations that have some ambiguity. * Consulting is a team sport so a demonstrated willingness and enthusiasm to collaborate with others is required. What We Offer * Highly competitive base salary plus performance-related bonus, 401K matching and Health & Dental benefits. * A strong values-based culture that promotes respect, inclusion and teamwork, encouragement to contribute and influence on the business - where everybody has a voice. * Leaders who are accessible, truly listen, are ambitious for our teams, and committed to coaching & sharing their expertise. * A high-growth, entrepreneurial environment where our thinking and our work are innovative, imaginative and bright. * Endless and tailored career development that stretches you and is based on your ambition, abilities and interests - not just box-ticking. * Flexible working, recognition for going the extra mile, and a flat hierarchy. More about Prescient Healthcare Group Prescient is a pharma services firm specializing in dynamic decision support and product and portfolio strategy. We partner with our clients to turn science into value by helping them understand the potential of their molecules, shaping their strategic plans and allowing their decision-making to be the biggest differentiating factor in the success of their products. When companies partner with Prescient, the molecules in their hands have a greater potential for success than the same science in the hands of their competitors. Founded in 2007, Prescient is a global firm with a footprint in ten cities across three continents. Our team of nearly 475 experts partners with 27 of the top 30 biopharmaceutical companies, the fastest-growing mid-caps and cutting-edge emerging biotechs, including some of the biggest and most innovative brands. More than 70% of our employees hold advanced life sciences degrees, and our teams deliver an impressive depth of therapeutic, clinical and commercial expertise. The annual full time base salary range for this role is ($75,000 - $85,000). Specific compensation is determined through interviews and a review of relevant education, experience, training, skills, geographic location and alignment with market data. Additionally, positions may be eligible to receive a discretionary bonus as determined by bonus program guidelines. Prescient offers PTO and paid holidays, the terms of which are set forth in the program policies. All full-time employees also are eligible to participate in various benefit plans, including medical, dental, vision, life, disability insurance and 401K; in each case in accordance with the terms of the applicable plans. Prescient has been a portfolio company of Bridgepoint Development Capital since 2021 and Baird Capital since 2017. For more information, please visit: ******************** We are an equal opportunity employer and fully comply with applicable legislation in all the geographies in which we operate. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable national, federal, state or local laws.

**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** $60,800.00 - $100,300.00 **Target Openings** 1 **What Is the Opportunity?** Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business property claims of moderate severity and complexity. Claims may also involve low severity building damage with some personal property and business personal property related to a wide variety of causes of loss. Claims can involve higher exposure depending on loss type and nature of the damaged property. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + 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. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + 2+ years previous inside property claim handling experience. + Interpersonal and customer service skills - Advanced. + Organizational and time management skills - Intermediate. + Ability to work independently - Intermediate. + Judgment, analytical and decision making skills - Intermediate. + Negotiation skills- Intermediate. + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively - Intermediate. + Investigative skills - Intermediate. + Ability to analyze and determine coverage - Intermediate. + Analyze, and evaluate damages - Intermediate. + Resolve claims within settlement authority - Intermediate. **What is a Must Have?** + High School Diploma or GED. + One year previous inside property claim handling experience or successful completion of Travelers Inside Claim Representative training program. **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 Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.

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! Complex Claims Specialist A&E About the Hiscox Claims team: The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling. 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 role is open to Atlanta, Boston, Chicago, Hartford or Manhattan and will be focused on servicing claims and potential claims arising from our Architects and Engineers 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 * Strategizing and maximizing early settlement opportunities * Monitoring litigation and managing local defense 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 experience with a JD from an ABA-accredited law school and bar admission in good standing or 10+ years relevant experience * A minimum of 2-3 years professional experience in the area of [Architecture & Engineering and/or Professional Liability]; coverage experience preferred * Excellent analytical skills * Excellent verbal and written communication skills * Strong ability to establish rapport and build relationships with clients * Team-oriented, with ability to excel in a collegial environment * 10% Travel Required Preferred: * A general understanding of insurance law * Prior experience with an insurance carrier preferred * Adjuster licensing is required within 90 days of employment Additional Factors Considered: * Ability to act a subject matter expert within team * Demonstrated ability to work with minimal oversight * Experience attending and leading mediations, arbitrations and trials * Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects * Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers * Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation * Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars. Hiscox Values: At Hiscox our spirit is in Challenging Convention and everything we do is guided by our Values. * Courage: Do the right thing however hard * Quality: World class where it matters * Integrity: True to our word * Excellence in Execution: Consistent, timely, efficient delivery * Human: Firm, fair and inclusive What Hiscox USA Offers: * Competitive salary and bonus (based on personal & company performance) * 401(k) with competitive company matching * Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) * Company paid group term life, short- term disability and long-term disability coverage * 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days * Paid parental leave * 4 week paid sabbatical after every 5 years of service * Financial Adoption Assistance and Medical Travel Reimbursement Programs * Annual reimbursement up to $600 for health club membership or fees associated with any fitness program * Company paid subscription to Headspace to support employees' mental health and wellbeing * 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 Please note that this position is hybrid and requires two (2) days in our office weekly Salary range: $125-$155k 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. About Hiscox: As an international specialist insurer we are far removed from the world of mass market insurance products. Instead we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things. We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions. Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places. Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch. About Hiscox USA: Hiscox USA was established in 2006 to focus on the needs underserved and specialty commercial clients via both the regional 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 400 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) #LI-RM1 Work with amazing people and be part of a unique culture

Equal Opportunity Employer/Disability/Veterans Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps. Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible. The Billing C laims Specialist focuses on claims and procurement of authorizations and medical documentation to ensure Reliable is reimbursed in accordance with the procedures provided. This position reports to the Billing Manager, but will perform duties that pertain to customer service, documentation retrieval, medical billing and coding, and reimbursement. The primary purpose of this position is to identify reasons for claim denials and take all corrective action to resubmit the claim and obtain full reimbursement for the services rendered. Additional duties include: Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services. Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures). Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins) Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice Issue invoices and bills and send them to customers through various channels (mail, e-mail etc.) Receive payments through various methods (cash, online payments etc.) and check for credibility. Answer questions and handle complaints from customers and payors regarding claims Reconcile deposits and invoices posted. Basic Qualifications 18 years of age or older Must be eligible to work in the United States and not require work authorization from us now or in the future Bachelor's Degree required At least 2 years of medical billing, coding, reimbursement or health insurance experience preferred Required Skills Strong health insurance knowledge of New England payers and Massachusetts ACO plans Proficient in obtaining authorizations in the most efficient manner (portal, fax form, phone in submission) Ability to learn Billing functions and be adaptable to the needs of the position. Strong interdepartmental communication Effective and professional verbal and written communication abilities Professional computer experience (especially Microsoft Office Suite) Ability to investigate problems and make decisions independently. Strong analytical skills Competencies Computer skills Interpersonal skills Product expertise Communication skills Results driven Conflict management Customer service Organizational skills Work Environment & Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time This role routinely uses standard office equipment such as computers, phones, and printers/scanners The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. This job operates in a professional office environment The noise level in the work environment is usually moderate to loud Direct Reports - 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. Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.

Working as part of the Claims Department, the Litigated Claims Specialist lends expertise in the laws, regulations, and jurisdictional statutes to identify or resolve disputed claims, assuring effective reimbursement. What You'll Do Investigate/rectify partial payments from claims in litigation Secure payment on outstanding invoices Investigate claim that are in litigation Assess current and ongoing risk of continued medications service in relation to ongoing litigation Research and act upon information obtained Interact and communicate daily with other departments Communicate with external sources such as attorneys and adjusters Obtain medical documentation to facilitate/warrant collections Analyze information and data for resolution Participate and develop special processes/procedures to better the Litigated Claims Team Special projects as designated by manager What You'll Need to Succeed 2+ years Workers Compensation knowledge Bachelor's Degree or equivalent related experience Familiar with medical terminology Knowledge of databases and MS Office (Excel & Word) Knowledge of IWP reimbursement process and procedures Make A Difference With IWP Injured Workers Pharmacy (IWP) is proud to be THE Patient Advocate Pharmacy, helping injured workers around the country access their prescription medications with ease. As a specialized workers' compensation home delivery pharmacy, we collaborate with the legal, medical, and insurance communities to help injured workers return to a productive life. At IWP we believe in our service, but it's the people who make it a great place to work. We value our employees and strive for a culture of teambuilding, open mindedness, and fun. If that sounds like something you'd like to be part of, we'd love to hear from you! Your compensation will include a competitive salary, generous benefits, and opportunities for growth and development. IWP is an Equal Opportunity Employer. IWP does not discriminate on the basis of race, creed, color, religion, national origin, sex, sexual orientation, gender identity, age, physical or mental disability, or any other basis covered by appropriate law. All employment decisions are made on the basis of qualifications, merit, and business need. IWP is committed to providing reasonable accommodations for qualified individuals with physical and mental disabilities in our job application procedures. If you need assistance or an accommodation due to a disability, you may contact us at humanresources@IWPharmacy.com We will make a determination on your request for reasonable accommodation on a case-by-case basis. We are dedicated to attracting and retaining top talent with competitive and fair compensation. The salary range for this role is $23/hr - $25/hr.

Job Description Our role as a Field Claims Representative will be responsible for the investigation, evaluation and settlement of assigned claims involving 1st Party Homeowner and Commercial Property claims. This role is a field-based position and will require travel to loss sites to evaluate the damages. This also includes special investigation activities with an emphasis on investigating possible fraudulent activity. This is a field based position, travel will be required within Southern Maine, with occasional travel to other areas as required. Responsibilities Field appraise losses of all types for both personal lines and commercial lines claims Take loss reports directly from insureds and/or claimants and/or their representatives. Appropriately handle incoming correspondence on assigned claim files. Investigate assigned claims - confirm coverage - verify damages. Effectively handle portions of claim investigations principally through on-site investigations, as warranted. Evaluate and settle assigned claims based upon the results of the investigation. A strong ability to work independently. Other related duties as assigned by supervisor including but not limited to aiding during CATs or other unusual spikes in claim volume. Requirements Bachelor's degree preferred or several years of direct experience 5-7 years of experience handling Property Claims; Commercial Lines experience a plus. Strong understanding of personal and commercial lines policy forms and coverage analysis. Multi-line adjuster's license as required in our operating territories. Demonstrated proficiency in writing detailed structural cost of repair/replacement estimates in Xactimate estimating system and proficient in PC Windows environment. Demonstrated proficiency in investigating, evaluating and settling contents claims. Excellent understanding and skill level of claim handling and customer service. Possess or has ability to timely secure and maintain required multiline adjuster licenses. Knowledge of policy contracts, insurance laws, regulations, and the legal environment in which we operate. Outside/Field Adjusters - ability to view damages and prepare estimates based on their inspection of the damaged property. Benefits At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness. Why Concord Group Insurance Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont. At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do. Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve. Compensation We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities. Equal Employment Opportunity The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state, or local law. The Concord Group participates in E-Verify

If you are a current State of Maine employee, you must complete your application through the internal application process (Find Jobs Report). Please apply using your PRISM account. If you are on Seasonal Leave and do not have access to PRISM, contact your local Human Resources representative for application information. Department of Labor Job Class Code: 0686 Grade: 21/Professional & Technical Salary: $21.54-$30.14/Hour Location: Presque Isle Opening Date: January 7, 2026 Closing Date: January 22, 2026 The Maine Department of Labor is seeking a detail-oriented and impartial Unemployment Claims Adjudicator to join our team. This position plays a critical role in evaluating unemployment benefit claims, interpreting state and federal laws, and ensuring program integrity. You will conduct investigations, make legally sound determinations, and support the fair administration of unemployment benefits. Why Work With Us Purposeful Work: Help ensure fairness and integrity in public benefit programs. Professional Growth: Learn, grow, and contribute in a dynamic regulatory environment. Supportive Team: Collaborate with a dedicated, mission-driven team. Primary responsibilities include: Interview claimants, employers, and witnesses-primarily by phone-to determine benefit eligibility and chargeable employer accounts. Analyze employment history, wage data, and separation information to reach accurate determinations. Write clear, well-reasoned decisions based on evidence and applicable laws. Explain laws, regulations, and policies to claimants, employers, and the public. Represent the Department in appeal hearings and court proceedings, providing testimony to support decisions. Investigates, research, and documents allegations of misrepresentation and fraudulent claims in order to determine validity and prepare reports of investigation. Plan, assign, and review work of support staff; provide training and oversight to ensure consistent and equitable application of rules. Knowledge of: Interviewing and investigative techniques. Research techniques and practices. Labor-management relations. Federal and state laws, rules, regulations, precedent cases, and agency manuals governing UC programs. Policies and procedures relating to the prevention, detection, and recovery of overpayments. Public sector and private industry employment practices. Quality Control Program goals and objectives. Ability to: Communicate effectively. Write clearly and effectively. Determine benefit eligibility. Interpret and apply laws, rules, and regulations in specific circumstances. Compile and analyze facts, reach logical conclusions, and make sound recommendations. Deal effectively with irate or confused clients. Demonstrate competent time management. Use desktop and laptop computers. Write complete and understandable decisions and reports. Plan, direct, and coordinate the work of subordinate staff. Train subordinate personnel Minimum qualifications: A Bachelors Degree in Business Administration, Human Resources, Economics, Finance, or related field and two (2) years of technical, administrative, or paraprofessional support level experience in public contact work which demonstrates interviewing, data gathering, and analytical skills. Comparable work experience may be substituted for education on a year-for-year basis. Preference will be given to those applicants: Experience adjudicating unemployment or public benefits claims Knowledge of Maine Employment Security Law Contact information: Questions about this position should be directed to ************************ Benefits of working for the State of Maine: No matter where you work across Maine state government, you find employees who embody our state motto-"Dirigo" or "I lead"-as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including: Work-Life Fit - Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. Health Insurance Coverage - The State of Maine pays 85%-95% of employee-only premiums ($11,196.96 - $12,514.32 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State. Dental Insurance - The State of Maine pays 100% of employee-only dental premiums ($387.92 annual value). Retirement Plan - The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS) for MSEA, or 18.91% for Confidential employees. State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness. Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time. There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If you're looking for a great next step, and want to feel good about what you do, we'd love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you're currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your lived experience and passion set you apart. . If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting.