Claim processor jobs in Texas

- 257 jobs

Claims Supervisor (Bodily Injury)
Geico 4.1
Claim processor job in Richardson, TX
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage: complex investigations coverage determinations liability assessments bodily injury claim resolutions-through both settlement and litigation. This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims. If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors: Ownership: You take responsibility for outcomes in all scenarios. Adaptability: You navigate dynamic environments with creativity and resilience. Leading People: You empower individuals and teams to achieve their best. Collaboration: You build and strengthen partnerships across organizational lines. Driving Value: You use data-driven insights to align actions with strategic goals. What You'll Do: Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust. Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims. Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations. Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention. Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service. Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence. Collaborate with leadership and cross-functional teams to identify and implement process improvements. Serve as a resource for team members on insurance-related questions providing mentorship and training to build their industry knowledge. What We're Looking For: Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases. Active Adjuster license (required) Expertise in Casualty claims, including knowledge of industry regulations and best practices Strong ability to assess needs and guide associates in negotiating claim settlements as needed Experienced in the use of various claims tools with ability to assist associates Strong adherence to compliance and regulatory requirements Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment Strong results orientation, with a history of meeting or exceeding performance goals Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations Ability to analyze data and metrics to inform decision-making and improve customer outcomes Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence Why Join GEICO? Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction. Inclusive Culture: Join a company that values diversity, collaboration, and innovation. Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit. Professional Growth: Access GEICO's industry-leading training programs and development opportunities: Licensing and continuing education at no cost to you. Leadership development programs and hundreds of eLearning courses to enhance your skills. Increased Earnings Potential: Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually. Incentives and Recognition: Corporate wide bonus programs are in place to reward top performers. Beware of scams! As a recruiter, I will only contact you through a @geico.com email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ***********************. keywords: litigation, auto liability, liability claims#geico300#LI-AL2 At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. Access to additional benefits like mental healthcare as well as fertility and adoption assistance. Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$49k-73k yearly est. Auto-Apply 5d ago
Legal Claims Analyst
Erisa Recovery
Claim processor job in Plano, TX
ERISA Recovery are experts in collecting complex and aged claims through the Federal ERISA appeals process. We are a fast-growing organization located in Plano, TX. If you would like to join a friendly, passionate team with limitless potential, we'd love to meet you. This extraordinary opportunity to advance your career and make a difference is now. We are searching for a Legal Hospital Claims Analyst - someone who works well in a fast-paced setting. In this position, you'll provide support in analyzing comprehensive claims and identifying key metrics. You will be a subject matter expert in legal claims. You must be able to work both independently and as part of a team. Key attributes for the ideal candidate include working with intensity, focus, and being detail oriented. Essential responsibilities and duties Conducts legal research and investigation of claims Drafting legal documents Keeping track of changes in legal framework and providing timely updates on these changes Utilizes ERISA law enforcement Utilizes knowledge of health care standards appropriate to specific claim Ability to understand and apply medical reimbursement policies, procedures, and standards Ensures eligibility for claims is reasonable and correct by analyzing claims and providing supporting documentation Utilize a variety of EHR systems Thrives in a fast-paced environment Collaborates effectively with other team members Ability to adapt to changing needs Consistently applies knowledge relevant to claims Work intensely at a fast-paced rate Ability to communicate effectively with third party administrators Determine the status of medical claims through research Meet the standards of the department and quality standards Strong organizational skills Desired skills and Qualifications Bachelor's degree 3+ years working in the legal field 2+ years working with healthcare insurance claims (preferred) Strong Communication skills Working knowledge utilizing Microsoft software (Word, Excel, Outlook) Ability to work in a fast-paced environment Benefits: 401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance Paid lunches Bonus ERISA Recovery is an Equal Opportunity Employer
$34k-55k yearly est. 3d ago
Technical Claims Specialist
Berkley 4.3
Claim processor job in Texas
Company Details Berkley Oil & Gas, (a W.R. Berkley Company) is an insurance underwriting manager providing unique property and casualty products and risk services to customers engaged in the energy sector. Our customers recognize the importance of the expertise we provide and appreciate the opportunity to work with professionals who understand their business. We are in turn committed to delivering innovative products and exceptional service to them, our valued agents and brokers, Berkley Oil & Gas is dedicated in its efforts to be well-informed of the changing dynamics of the industry; support industry efforts to minimize and mitigate risks and hazards in the ‘oil patch', and to constantly seek ways to improve our products and services to meet customer needs. Company URL: *************************** The company is an equal opportunity employer. Responsibilities The Technical Claims Specialist position will be responsible for handling, negotiating and resolving first and third party commercial general liability, property, Inland Marine and automobile bodily injury and property damage claims to conclusion. This position may also handle worker's compensation claims. This would include coverage verification, policy interpretation, contract interpretation, liability investigation and evaluation and negotiation of claims consistent with company policies and state regulations. Conduct and manage the investigative process, while demonstrating ongoing communication with the customer and relevant internal and external parties. Documenting files to include all key activities, contacts made, statements taken, including a full outline covering all aspect of the claim requirements for resolution. Demonstrate understanding of medical terms, medical treatment and injury descriptions. Recognition and evaluation of potential damages related to injuries. Manage the claim authorization process. Conduct complete investigation of losses through appropriate techniques including interviews, recorded statements, documentation/data gathering and securing/preserving evidence. Evaluate compensability and exposure; identify subrogation opportunities or suspicious claims. Prepare timely, concise reports and state filings as required by the jurisdiction. Promptly establish and maintain accurate reserves. Adhere to state regulatory compliance requirements. Verify, analyze, and correctly apply coverage. Develop strategy and negotiate claims to a timely conclusion, properly applying state compliance and company policies and procedures. Develop a resolution plan (e.g. pay, deny, dispute) based upon analysis of the facts, defenses, compensability, and statutory/case law. Keep policyholders, underwriting and agents advised of file status and other matters as required. Participation in presentations, meetings, or visits to agents, policyholders, prospective accounts and other groups related to claims resolution, service or technical issues. Successfully complete relevant continuing education as required. Qualifications Minimum of 7 years of multi-line experience Must possess a current Texas claims adjuster licenses; additional licenses a plus. Multi-jurisdictional experience preferred. Familiarity with Contractual Risk Transfer concepts and anti-indemnity laws Ability to follow detailed procedures and ensure accuracy in documentation and data. Excellent written and verbal communications; with ability to listen well. Recognizes differences in opinions and misunderstandings and encourages open discussion while working towards resolution. Accepts individual responsibility for all actions taken. Holds self and others accountable to the organization and stakeholders. Excellent organizational skills; ability to prioritize workload Ability to think critically and solve problems, including the ability to interpret related documentation Strong negotiation skills leading to best claim outcomes Demonstrate proficiency in computer programs, such as Microsoft Word, Outlook and Excel Education Requirement Bachelor's Degree required or equivalent work experience. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $90,000 - $140,000 • Eligible to participate in annual discretionary bonus. • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. 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. The application window for this role is estimated to be open through January 30, 2026, but may be extended, if necessary, please submit your application as soon as possible prior to January 30, 2026. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
$90k-140k yearly Auto-Apply 4d ago
Claims Processor
Pennymac 4.7
Claim processor job in Fort Worth, TX
PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U. S. mortgage loans and the management of investments related to the U. S. mortgage market. At Pennymac, our people are the foundation of our success and at the heart of our dynamic work culture. Together, we work towards a unified goal of helping millions of Americans achieve aspirations of homeownership through the complete mortgage journey. Job Overview The Claims Processor is a specialized role within the mortgage industry, primarily focused on the financial aspects and reimbursement of fees, costs and advances that incurred during the foreclosure process. A Typical Day The Claims Processor will take direction from the department supervisor for post-sale functions, such as: evictions, property maintenance, conveyance of title, title delivery, and adherence to GSE servicing requirements during the REO process. As the Claims Processor, you will be responsible for filing MI, investor, and insurer claims timely and accurately, providing all back-up as requested, and the reconciliation and posting of claim proceeds. The Claims Processor will: Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including: eviction management, property inspection and maintenance, conveyance of title, title delivery, maintenance of HOA, taxes, and property insurance during the GSE REO process File claims for reimbursement of expenses Reconcile claim proceeds File supplemental claims as needed Ensure data accuracy Perform other related duties as required and assigned Demonstrate behaviors which are aligned with the organization's desired culture and values What You'll Bring High School Diploma / GED 1+ years of relevant work experience Default-related experience preferred Demonstrated aptitude for data, reporting, and working with numbers, desired Familiar with GSE and Insurer servicing guidelines Must be highly proficient in Excel and Word Why You Should Join As one of the top mortgage lenders in the country, Pennymac has helped over 4 million lifetime homeowners achieve and sustain their aspirations of home. Our vision is to be the most trusted partner for home. Together, 4,000 Pennymac team members across the country are guided by our core values: to be Accountable, Reliable and Ethical in all that we do. Pennymac is committed to conducting a business that makes positive contributions and promotes long-term sustainable growth and to fostering an equitable and inclusive environment, where all employees and customers feel valued, respected and supported. Benefits That Bring It Home: Whether you're looking for flexible benefits for today, setting up short-term goals for tomorrow, or planning for long-term success and retirement, Pennymac's benefits have you covered. Some key benefits include: Comprehensive Medical, Dental, and Vision Paid Time Off Programs including vacation, holidays, illness, and parental leave Wellness Programs, Employee Recognition Programs, and onsite gyms and cafe style dining (select locations) Retirement benefits, life insurance, 401k match, and tuition reimbursement Philanthropy Programs including matching gifts, volunteer grants, charitable grants and corporate sponsorships To learn more about our benefits visit: ********************* page. link/benefits For residents with state required benefit information, additional information can be found at: ************ pennymac. com/additional-benefits-information Compensation: Individual salary may vary based on multiple factors including specific role, geographic location / market data, and skills and experience as defined below: Lower in range - Building skills and experience in the role Mid-range - Experience and skills align with proficiency in the role Higher in range - Experience and skills add value above typical requirements of the role Some roles may be eligible for performance-based compensation and/or stock-based incentives awarded to employees based on company and individual performance. Salary $39,000 - $55,000 Work Model OFFICE
$39k-55k yearly Auto-Apply 19d ago
Insurance Claims Specialist
DPR Construction 4.8
Claim processor job in Dallas, TX
The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager. Specific Duties include: Claims & Incident Management: Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to: Input and/or review all incidents reported in DPR's RMIS system. Maintain incident records in Insurance Team's document management system. Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements. Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities. Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable. Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate. Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date. Provide in-network aluminum certified repair shop information to drivers following an incident. Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement. When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form. Work with Insurance Controller on auto program claim reports Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed. Fleet Vehicle Safety & Operations Policy Management: Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training Ensure authorized driver list is kept current Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy Key Skills: Strategic thinking Ability to mentor and inspire others Integrity Team player Strong writing and communication skills Self-Starter Highly organized and responsive - ability to meet deadlines Detail Oriented Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs. Risk and dispute management - insured claims Qualifications: A minimum of five years relevant insurance industry experience Previous experience in auto claims management highly desired DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world. Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek. Explore our open opportunities at ********************
$57k-73k yearly est. Auto-Apply 60d+ ago
Claims Specialist - Auto
Philadelphia Insurance Companies 4.8
Claim processor job in Plano, TX
Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
$82.8k-97.3k yearly Auto-Apply 60d+ ago
Risk Claims Specialist
Maya Management Group LLC 4.1
Claim processor job in Dallas, TX
Job Description Key Responsibilities: Customer Claims: • Manage Customer Injury and Liability Claims: Oversee the investigation, documentation, and resolution of customer claims related to personal injury, property damage, or any other incidents occurring on organization premises. • Coordinate with Insurance Providers: Liaise with insurance companies to ensure proper claims filing and coordinate the resolution of claims involving external parties. • Customer Support: Handle escalated customer claims and provide appropriate resolutions while ensuring the store's best interests are maintained. • Documentation & Compliance: Ensure that all claims are properly documented in compliance with company policies and legal requirements. Keep detailed records of each customer-related claim. • Risk Prevention: Identify trends or recurring incidents that may contribute to customer claims and work with store management to implement safety measures or preventive actions. Employee Claims: • Workers' Compensation Claims: Oversee and manage all workers' compensation claims, ensuring compliance with state and federal regulations, and ensuring employees receive appropriate benefits. • Workplace Injury Claims: Manage the investigation of employee injury claims, including gathering evidence, interviewing witnesses, and ensuring all necessary forms are completed and submitted on time. • Fleet Claims Management: Manage the investigation of employee fleet claims, support employee's injuries if any, gather witness statements • Support and Guidance: Provide support to injured employees, ensuring they are informed throughout the claims process and are aware of their rights and available benefits. • Collaboration with HR and Legal: Work with HR and legal teams to ensure employee-related claims are handled correctly and in compliance with labor laws, insurance regulations, and company policies. • Collaboration with Safety Team: Work with the Safety Team to consistently do store visits, conduct safety audits, checklists and investigations as needed. Development: • Process Improvement: Identify opportunities to improve the claims process, whether through more efficient systems, better documentation, or enhanced communication strategies. Risk Management and Reporting: • Claims Analysis and Reporting: Review and analyze the data on claims to identify trends, recurring issues, or areas for improvement. Prepare detailed reports for management regarding claim frequency, costs, and risk mitigation efforts. • Collaboration with Risk and Safety Teams: Work closely with the Risk Management and Safety teams to address underlying causes of incidents that may lead to claims and develop preventive strategies. • Compliance: Ensure that all claims are processed in line with company policies, industry standards, and legal requirements, including managing documentation for audits or regulatory reviews. • Invoices: Reconcile and verify all invoices generated from claims. • Safety Monitor Report: Complete Safety Monitor report and communicate all parties involved to resolve an issue related to an investigation. Qualifications: • Bachelor's degree in Business, Risk Management, Insurance, or a related field (or equivalent experience). • 3-5 years of experience in claims management, risk management, or a specialist role, preferably in a retail or supermarket environment. • Strong understanding of risk management principles, insurance claims processes, and workers' compensation regulations. • Strong problem-solving and analytical abilities to investigate and resolve complex claims efficiently. • Excellent communication skills, both written and verbal, with the ability to manage sensitive issues with customers and employees. • Attention to detail and ability to maintain accurate records and reports. • Proficient in Microsoft Office and experience with claims management software or risk management tools. Physical Requirements: • Ability to stand for extended periods • Ability to lift up to 50 lbs as needed Work Environment: • Fast-paced, high-volume environment • Occasional evening, weekend, or holiday work may be required • Occasional travel to different company locations Physical Demands: Some lifting, carrying, pushing, and/or pulling; some stooping, kneeling, crouching, and/or crawling; and significant fine finger dexterity. Generally, the job requires 70% sitting, 20% walking, and 10% standing. This job is performed in a generally clean and healthy office environment.
$37k-65k yearly est. 5d ago
General Liability Claims Specialist
CNA Holding Corporation 4.7
Claim processor job in Plano, TX
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). This position enjoys a flexible, hybrid work schedule and is available in any location near a CNA office. JOB DESCRIPTION: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically, Manager or above Skills, Knowledge & Abilities Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. Demonstrated ability to develop collaborative business relationships with internal and external work partners. Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. Demonstrated investigative experience with an analytical mindset and critical thinking skills. Strong work ethic, with demonstrated time management and organizational skills. Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. Developing ability to negotiate low to moderately complex settlements. Adaptable to a changing environment. Knowledge of Microsoft Office Suite and ability to learn business-related software. Demonstrated ability to value diverse opinions and ideas Education & Experience: Bachelor's Degree or equivalent experience. Typically, a minimum four years of relevant experience, preferably in claim handling. Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. Professional designations are a plus (e.g. CPCU) #LI-LG1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$54k-103k yearly Auto-Apply 60d+ ago
Paralegal/Claims Specialist
The Sundt Companies 4.8
Claim processor job in Irving, TX
JobID: 9100 JobSchedule: Full time JobShift: : As a 100% employee-owned contractor, when you work at Sundt, you're not just hiring on at a company, you're joining a culture. Because everyone at Sundt is part owner, you'll join a team of people who are deeply invested in their work. From apprentices to managers, we're passionate about the details and deliberate in everything we do. At Sundt we focus on building long-term prosperity for our clients, communities, and employee-owners. We offer competitive pay, industry-leading benefits including a 401k and employee stock ownership plan, incentive programs for craft and administrative employees as well as training that focuses on your personal and professional growth. We're driven by skill, grit and purpose. Join us as we strive to be the most skilled builder in America. Job Summary The Paralegal / Claims Specialist supports the company's Legal and Risk Management functions by assisting attorneys and insurance professionals in the investigation, evaluation, and resolution of claims and lawsuits. The role involves direct collaboration with outside counsel, insurance adjusters, and internal Safety and Operations teams. The Paralegal/Claims Specialist will independently manage the day-to-day handling of routine litigation and claims matters, including discovery, documentation, and coordination with defense counsel. Key Responsibilities 1. Assists attorneys with trial preparation, exhibits, witness coordination, and logistics. 2. Assists company attorneys with responding to non-party subpoenas and regulatory inquiries. 3. Attends mediations, depositions, and hearings as appropriate to support counsel, our internal personnel and maintain awareness of case progress. 4. Communicates directly with claimants, witnesses, experts, and internal personnel to obtain and analyze relevant information, including managing internal electronic data preservation in coordination with IT team, and oversee transfer of preserved data for discovery. 5. Coordinates with Safety personnel regarding incident intake, documentation, and potential claims escalation. 6. Drafts and edits legal documents including correspondence, discovery requests and responses, routine pleadings, affidavits, and case summaries. 7. In conjunction with attorneys, manages litigation, including coordinating discovery and e-discovery, tracking deadlines, managing document production, approving and processing legal invoices and maintaining organized case files. 8. Maintains accurate and up-to-date records in Risk Information Management Systems {RIMS) or other claims databases. 9. Reviews and analyzes claims in coordination with legal and risk management professionals determine liability, damages, and insurance coverage. 10. Works closely with company attorneys, outside counsel, and insurance adjusters to investigate, evaluate, and resolve claims and lawsuits. Minimum Job Requirements 1. 5-10 Years of Experience 2. Bachelor's degree 3. Knowledge working for a law firm or an insurance company representing clients in responding to claims and lawsuit preferred. 4. Paralegal certification Note: is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 50Ibs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Note: Job Description is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 501bs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Equal Opportunity Employer Statement: Sundt is committed to the equal treatment of all employees, and/or applicants for employment, and prohibits discrimination based on race, religion, sex (including pregnancy), sexual orientation, gender identity, color, age, disability, national origin, covered veteran status, genetic information; or any other classification protected by applicable Federal, state, or local laws. Benefit list: Market Competitive Salary (paid weekly) Bonus Eligibility based on company, group, and individual performance Employee Stock Ownership Plan & 401K Industry Leading Health Coverage Starting Your First Day Flexible Time Off (FTO) Medical, Health Savings, and Wellness credits Flexible Spending Accounts Employee Assistance Program Workplace Wellness Programs Mental Health Program Life and Disability Insurance Employee-Owner Perks Educational Assistance Sundt Foundation - Charitable Employee-Owner's program #LI-KA1
$45k-61k yearly est. Auto-Apply 18d ago
Complex Claims Specialist
Lockton 4.5
Claim processor job in Dallas, TX
Lockton is currently seeking a Clinical Claims Specialist within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims, reduce the cost of risk while improving the health of our employer client's employee health plan. * Provide explanation of disease states and associated costs to internal and external stakeholders. * Provide cost-of-care estimates used in the risk assessment of stop loss underwriting. * Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals. * Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims. * Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction. * Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan. * Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance. * Manage and organize task lists and open items and cases. * Attend team clinical rounds to discuss cases and strategy solutions.
$36k-49k yearly est. 4d ago
Claims Specialist III
Inshur 4.0
Claim processor job in Dallas, TX
Are you keen to work somewhere that's stimulating and friendly, with loads of opportunities for growth and plenty of freedom to make a real impact? This could be the place for you! We are looking for a Claims Specialist III (CS3) to join us at INSHUR! We're based in Dallas, TX , with offices in New York City and Westlake, CA ️ and our company embraces a hybrid working model, allowing you to thrive in both collaborative office settings and the comfort of your own home . You'll have the opportunity to work remotely while also connecting with your colleagues at our Dallas office 3 days a week initially and reducing to 1 day a week following your orientation, typically 90 days, fostering a dynamic and supportive environment. Supported by (and reporting to) Claims Manager and Team Leaders, you'll be joining a friendly team of 29 specialists who believe in delivering great customer service at scale. We value high performance and care deeply about making INSHUR a place where everyone is building something special, that we can all be proud of, while enjoying the ride. What you'll do As our Claim Specialist III (CS3) you will be responsible for handling and resolving commercial auto claims across the United States. The claims that are assigned to you will involve coverage investigations, liability negotiations, third-party bodily injury, and depending on your experience litigation. You will be responsible for setting and maintaining reserves, assigning defense counsel, negotiating settlements with attorneys, issuing payments, and interpreting policy contracts. While we prioritise aptitude and passion over a strict checklist of requirements, we've outlined a core set of skills we believe will lead to success in this role. To make things clear, we've categorised them into "essentials to thrive in the role" and "additional skills that could set you apart" We'd love to hear from you if you have …these essentials to thrive in the role; * Experience handling third-party bodily injury claims in a personal auto or commercial auto space at a recognized insurance carrier * Have already secured an insurance license in Texas. * Ability to secure a license in California and New York within 60 days. * Enjoy working in a fast-paced environment. * Understand that customer satisfaction and retention is driven by handling claims well. * Are passionate about building a successful career in Claims. * Helped resolve customer concerns in your most recent role. * Understand the value of contributing to a team's shared success. * Ability to work from our office in Irving, TX 3 days a week during your first 2 weeks and then 2 days a week for 90 days. After successful completion of trial period, this will reduce to 1 day a week. … these additional skills that could set you apart * A bachelor's degree is strongly preferred. You'll love it here if you: Thrive navigating ambiguity and finding clarity in uncertain situations. Take pride in being accountable and owning your responsibilities. Enjoy in a fast-paced environment where change happens quickly. Are solutions-focused and driven to overcome challenges. Embrace resilience and adapt to setbacks with a positive attitude. Are intellectually curious, constantly seeking to learn, explore new ideas, and not afraid to question and improve your understanding. You may not enjoy working here if: Prefer a more structured, slow-moving environment. Feel most comfortable when tasks and processes are clearly defined from the start. Struggle with handling multiple challenges at once or adapting to frequent changes. Tend to stick strictly to your defined role and avoid contributing outside of your responsibilities. What to expect from the process: Screen & Intro: 20-minute call with the Talent Team to discuss the role and your experience. First Interview: 60- 90 minute onsite interview with a Claims Manager or Team Lead and People Partner to delve into the role, including technical questions and an opportunity for you to ask questions, followed by a brief case study to demonstrate your skill set in a practical setting. What we offer We offer all our employees a competitive salary and stock options. We've also built a benefits package that invests in our people's long-term personal and professional growth and wellbeing. Here's a sample of what this includes: 25 days of holiday (+5 days after 5 years), 5 sick days and 8 federal holidays Medical, dental and vision health insurance plans ️ Life insurance, short-term, and long-term disability benefits 13 weeks fully paid parental leave for all new parents, regardless of your gender 401(k) with 4% company match Commuter Benefits Flexible working hours to fit your lifestyle $650 annual training allowance & learning opportunities ️ $50 monthly wellbeing and home setup allowance 24/7 Employee Assistance Program and mental health benefits It goes without saying that we provide everyone with a laptop, monitor, top of the range kit, and any software you need. About Us INSHUR is on a mission to be the leader in insurance solutions for the on-demand economy, making coverage fair and accessible for drivers. Cutting edge technology & deep insurance know-how underpins our revolutionary offering for on-demand drivers, keeping premiums affordable and delivering results for partners. With a focus on embedded insurance solutions, and complementary technology integrations for digital platform providers such as Uber, Amazon, Bolt, FREENOW and OLA, we've been helping drivers stay on the road since 2016 through our data, technology and in-house insurance expertise. Backed by some of the most forward thinking VC's including Viola Growth, JVP, Munich Re, Viola Fintech, MTech Capital, Antler, and MS&AD, we have secured over $113.5 million in funding as well as the acquisition of American Business Insurance in 2023. We have exciting plans to continue growing our portfolio and product lines and expand to new territories in the future. As a global team of around 220 people based across the US, UK, and the Netherlands, we value: Generosity, inclusivity, open-mindedness, and diversity Delivering great results and learning in the open Freedom to make long-term, high-impact decisions The wellbeing of our teammates and the people around us And… Enjoying the ride! Equal opportunities At INSHUR, we believe that having a diverse team where everyone can bring their authentic selves to work is key to our success. We're passionate about creating equal opportunities and making the tech industry a better place for all and we don't discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, marital status, disability, or age. As at Aug 2025, our team consists of 46% women, 31% from BAME or BIPOC backgrounds, and 12% LGBTQ+ . We proudly represent 30+ nationalities and span multiple generations, including Baby Boomers, Gen X, Millennials, and Gen Z. We're proud to have been recognised for Diversity and Inclusion by the British Insurance Awards . We recognise that some companies often hire people similar to the existing team-something we've worked hard to overcome. We follow a structured hiring process and ensure our interview teams are trained to foster inclusivity and equity. While this position is advertised as full-time, we're flexible on specific arrangements and happy to discuss options like part-time, job-sharing, or other flexible work setups for the right candidate. ️ If you need any adjustments during the interview process, please let us know, and we'll do our best to accommodate your needs.
$37k-65k yearly est. 26d ago
Auto Claims Specialist
Toyota Insurance Management Solutions
Claim processor job in Plano, TX
Who are we: Toyota Insurance is a brand name of Toyota Insurance Management Solutions USA, LLC (TIMS). We are an independent agency specializing in property and casualty insurance for Toyota vehicle owners. We offer insurance through our trusted carrier partners to provide coverage for your Toyota vehicle, home and other assets. Our mission is to improve the Toyota ownership experience by improving the insurance experience. Job Overview: We are seeking a detail-oriented and proactive Auto Claims Specialist to join our team and support the auto property damage claims process. This role combines technical expertise in auto damage assessment with advocacy and coordination between internal and external stakeholders to ensure timely, accurate, and fair resolution. The ideal candidate will possess strong analytical skills, attention to detail, and excellent communication abilities with the desire to grow within the claims and insurance operations field. Job Responsibilities: Claims Intake & Documentation: Receive initial auto claim and damage information from internal teams or external parties. Collect, review, and validate all relevant supporting documentation such as police reports, First Notice of Loss (FNOL), recorded statements, and any other applicable claims information for accuracy and completeness. Accurately enter claims and damage data into the claims management system (Nexure). Must have a solid understanding of rideshare insurance policies, including how coverage exclusions apply and impact claims. File Management & Reporting: Organize and maintain secure auto claim files and records in compliance with company and regulatory standards. Submit loss notices and report claims promptly to insurance carriers. Prepare and submit any additional applicable claims or inquiries as required. Damage Review & Estimation: Review and document auto damages thoroughly. Analyze and validate repair estimates for vehicle damages. Coordinate with repair shops to discuss damages and confirm accuracy of estimates. Repair Process Oversight: Examine and evaluate repair processes and timelines. Monitor repairs through completion, ensuring quality and adherence to agreed timelines. Communication & Collaboration: Serve as the primary liaison between internal departments, vendors, external stakeholders, attorneys, and carriers. Provide clear and timely updates to all parties involved in the claim process. Claims Evaluation & Escalation: Review claim settlement recommendations for accuracy and fairness. Collaborate with senior claims analyst on complex or high-risk claims and escalate as necessary. Required Education and Experience: Licensed as an Adjuster in the State of Texas. 3 to 5 years of experience in auto insurance claims, auto claims adjusting, advocacy and/or auto claims estimation. Strong knowledge of insurance policies, auto repair processes and claims regulations. Knowledge of and experience in auto claims involving public or livery passenger conveyance policy exclusions and endorsements. Excellent organizational, time management skills, and communication skills. Strong understanding of the complete auto claims process, from initial intake to final resolution. Ability to work independently with minimal supervision. Preferred Skills: Strong analytical and problem-solving abilities. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and claims management systems. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Insurance agency, brokerage, or agent knowledge and/or experience is a plus. Strong attention to detail and organizational skills. Core Competencies: Analytical Thinking: Ability to interpret complex data, identify trends, and make informed decisions to resolve claims efficiently. Attention to Detail: Ensures accuracy in documentation, compliance with regulatory requirements, and thorough investigation of claims. Problem-Solving: Skilled in evaluating claim scenarios and developing effective solutions to minimize risk and optimize outcomes. Communication Skills: Strong written and verbal communication for interacting with internal teams, external partners, and clients. Work Environment and Physical Demands: Ability to work within a Team environment under tight schedules. Willingness to work evenings or weekends, as dictated by the needs of the business. Compensation: Base Salary: $46,000-$60,000 based on skills and experience Onsite-Plano office What are the Perks? Medical, Dental & Vision Insurance Paid Time Off, Paid Holidays and Sick Days 401(k) Match FSA and HSA Pet Insurance Life Insurance Degree of Travel: None Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Work Authorization: Applicants must be authorized to work for any employer in the U.S. This position does not offer sponsorship or the transfer of sponsorship of employment Visa. Learn More: Visit our website Toyota Insurance: *********************************** to learn more about our company culture and career opportunities. FLSA Job Status: ☒ Exempt ☐Non-Exempt All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. An Equal Opportunity Employer: Female / Minority / Disability / Protected Veteran / Sexual Orientation / Gender Identity EEOC is The Law' Information: ******************************************************************************
$46k-60k yearly 25d ago
Claim Specialist Clerk
Autobuses Ejecutivos
Claim processor job in Houston, TX
We are expanding our team and seeking a dedicated Claims Specialist with experience in insurance policy renewals to support our risk management and insurance operations. The Claims Specialist will manage insurance claims related to company operations and oversee the renewal of insurance policies to ensure ongoing compliance, protection, and operational continuity. Key Responsibilities: *Process and manage insurance claims from initial report through final resolution. *Review claim documentation, assess damages, and ensure alignment with insurance regulations and company procedures. *Liaise with insurance carriers, adjusters, legal teams, and internal departments. *Lead and coordinate the insurance policy renewal process, ensuring accurate documentation and timely submission. *Maintain updated records for all claims and policy renewals. *Provide internal support on claim status, policy requirements, and insurance-related inquiries. *Identify opportunities to reduce risk and improve claims procedures. Requirements: *Proven experience as a Claims Specialist, preferably within the transportation or logistics industry. *Strong background in insurance policy renewal management. *Knowledge of insurance principles, claims workflows, and regulatory requirements. *Excellent communication and negotiation abilities. *Strong analytical and organizational skills with high attention to detail. *Ability to work independently and manage multiple cases simultaneously. *Proficiency with insurance platforms and MS Office Suite. What Omnibus Express Offers: *Competitive salary and comprehensive benefits package. *Opportunities for professional development and career advancement. *A collaborative and supportive workplace culture. How to Apply: Please send your resume and cover letter to ******************************** with the subject line: Claims Specialist - Omnibus Express. or apply in our website omnibusexpress.com or Indeed Benefits: 401(k) 5% Match Dental insurance Employee discount Health insurance Paid time off Vision insurance Work Location: In person
$30k-53k yearly est. Auto-Apply 4d ago
Claims Processing Specialist
Saferide Health
Claim processor job in San Antonio, TX
SafeRide Health is looking for a hands-on Claims Specialist to scale SafeRide. We are looking for a leader with deep experience managing Medicare and Medicaid programs as we scale past $100M in annual revenue. The Billing Specialist is responsible for elevating SafeRide's billing function and continuously enhancing the effectiveness of the organization. Strong business and financial orientation as well as a passion for growth and development are critical for this role. Responsibilities: * Facilitates data processing and processes claims for NEMT and GMR rides. * Performs reconciliation of billing data to encounter data. Works closely with the operations team to resolve issues. * Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations. * Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines. * Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner. * Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules. * Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team. * Served as the Billing team's subject matter expert and primary contact for claims related projects and critical activities. * Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues. * Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas). * Champion and reinforce SafeRide's culture. Required Education/Experience: * Minimum 1 years of experience in billing/claims management * Must be bilingual Spanish Speaking Preferred * NEMT/transportation background preferred * Knowledge of CMS/HHSC regulations preferred Skills * Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc. * Self-starter, ability to work independently and in a team environment. * Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions * Ability to adapt to unforeseen circumstances quickly * Keen attention to detail * Ability to work with a variety of stakeholders What we offer you * An inclusive, encouraging and collaborative company culture * Strong support for career growth, including access to our investor communities * Competitive compensation with upside for growth (including stock options and performance grants) * Competitive benefits including health/vision/dental insurance, 401k match and 18 day's PTO About SafeRide Health: SafeRide's mission is to restore access and dignity to care. SafeRide is transforming access to care for the nations sick, poor and underserved. We are a high growth, tech enabled services firm that's growing past 400 employees. SafeRide is backed by premier investors like NEA and clients like Fresenius. We operate nationally and now deliver over 5M rides per year. Learn more at ***********************
$27k-36k yearly est. 46d ago
Pharmacy Claims Adjudication Specialist
Onco360 3.9
Claim processor job in Houston, TX
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Houston, TX. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $20.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 1, 2026. We offer a variety of benefits including: Medical; Dental; Vision 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360... Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information.. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim. Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible) Manages all funding related adjudications and works as a liaison to Onco360 Advocate team. Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable. Document and submit requests for Patient Refunds when appropriate. Pharmacy Adjudication Specialist Qualifications and Responsibilities... Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience Work Experience Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience Skills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills Desired: Knowledge of Foundation Funding, Specialty pharmacy experience Licenses/Certifications Required: Registration with Board of Pharmacy as required by state law Desired: Certified Pharmacy Technician (PTCB) Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills #Company Values: Teamwork, Respect, Integrity, Passion
$20 hourly 21d ago
Claims Specialist
Crouch Staffing Solutions, Inc.
Claim processor job in Waco, TX
Job Description Crouch Staffing Solutions, Inc. in Hewitt, Texas is hiring for a Claims Specialist for a Waco area company. All of our services are free for prospective employees. Location: Waco, TX 76710Job Title: Claims Specialist (Call Center) Job Type: Full-time Pay/Salary: $17.00 per hour Hours of Work: Monday -Friday, 8 AM - 5 PM ROLE SUMMARY:The Claims Specialist will be responsible in processing life, disability, and waiver of premium claims by providing patient, empathetic, customer service to policy-related personnel regarding their claim. This is handled via telephone, e-mail, fax, or by sending letters through the mail. In addition, perform the various claim functions as listed below. DAILY RESPONSIBILITITES: Collecting information through handling incoming calls, ensuring timely and courteous verification. Inform clients about processes, procedures, and expectations in a clear and helpful manner. Coordinate the necessary documentation for claims processing, utilizing both internal systems and external resources. Generate letters and update claim systems for newly reported claims. Address and follow up on outstanding requirements for pending claims, resolving them efficiently. Investigate and gather essential data from various sources such as beneficiaries, physician records, medical facilities, legal documents, etc., to facilitate effective claims processing. Record detailed notes related to interactions with policy-related personnel. REQUIREMENTS: Successful performance in this role demands the following qualifications. The criteria listed below illustrate the knowledge, skills, and abilities necessary. Reasonable accommodations may be considered for individuals with disabilities. Effective communication skills, both written and verbal. Proficiency in handling multi-line phone systems, with the ability to route and escalate calls as required. Exceptional interpersonal skills, fostering positive relationships. • Strong organizational and time management capabilities. • Patient and empathetic demeanor. • Active listening skills. • Adaptability and flexibility in dynamic work environments. • Comfortable working within fast-paced settings. • Troubleshooting skills, varying from basic to advanced based on role and industry. • Proficient computer skills, including data entry proficiency. • Adherence to all applicable laws, regulations, and contractual obligations while conducting company business with ethics and integrity, aligning with the Compliance Program principles. EDUCATION, WORK EXPERIENCE, and TRAINING REQUIREMENTS: • High School Diploma or general education degree (GED) is required • Preference for life claims experience, though not mandatory. • Prior experience in call centers and customer service is strongly preferred PLEASE APPLY AT www.crouchstaffing.com
$17 hourly 29d ago
Mortgage Claims Processor
Pennymac 4.7
Claim processor job in Fort Worth, TX
PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U. S. mortgage loans and the management of investments related to the U. S. mortgage market. At Pennymac, our people are the foundation of our success and at the heart of our dynamic work culture. Together, we work towards a unified goal of helping millions of Americans achieve aspirations of homeownership through the complete mortgage journey. A Typical Day The Claims Processor will take direction from the department supervisor for post-sale functions, such as: evictions, property maintenance, conveyance of title, title delivery, and adherence to GSE servicing requirements during the REO process. As the Claims Processor, you will be responsible for filing MI, investor, and insurer claims timely and accurately, providing all back-up as requested, and the reconciliation and posting of claim proceeds. The Claims Processor will: Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including: eviction management, property inspection and maintenance, conveyance of title, title delivery, maintenance of HOA, taxes, and property insurance during the GSE REO process File claims for reimbursement of expenses Reconcile claim proceeds File supplemental claims as needed Ensure data accuracy Perform other related duties as required and assigned Demonstrate behaviors which are aligned with the organization's desired culture and values What You'll Bring High School Diploma / GED 1+ years of relevant work experience Default-related experience preferred Demonstrated aptitude for data, reporting, and working with numbers, desired Familiar with GSE and Insurer servicing guidelines Must be highly proficient in Excel and Word Why You Should Join As one of the top mortgage lenders in the country, Pennymac has helped over 4 million lifetime homeowners achieve and sustain their aspirations of home. Our vision is to be the most trusted partner for home. Together, 4,000 Pennymac team members across the country are guided by our core values: to be Accountable, Reliable and Ethical in all that we do. Pennymac is committed to conducting a business that makes positive contributions and promotes long-term sustainable growth and to fostering an equitable and inclusive environment, where all employees and customers feel valued, respected and supported. Benefits That Bring It Home: Whether you're looking for flexible benefits for today, setting up short-term goals for tomorrow, or planning for long-term success and retirement, Pennymac's benefits have you covered. Some key benefits include: Comprehensive Medical, Dental, and Vision Paid Time Off Programs including vacation, holidays, illness, and parental leave Wellness Programs, Employee Recognition Programs, and onsite gyms and cafe style dining (select locations) Retirement benefits, life insurance, 401k match, and tuition reimbursement Philanthropy Programs including matching gifts, volunteer grants, charitable grants and corporate sponsorships To learn more about our benefits visit: ********************* page. link/benefits For residents with state required benefit information, additional information can be found at: ************ pennymac. com/additional-benefits-information Compensation: Individual salary may vary based on multiple factors including specific role, geographic location / market data, and skills and experience as defined below: Lower in range - Building skills and experience in the role Mid-range - Experience and skills align with proficiency in the role Higher in range - Experience and skills add value above typical requirements of the role Some roles may be eligible for performance-based compensation and/or stock-based incentives awarded to employees based on company and individual performance. Salary $39,000 - $55,000 Work Model OFFICE
$39k-55k yearly Auto-Apply 35d ago
Technical Claims Specialist
Berkley 4.3
Claim processor job in Houston, TX
Company Details Berkley Oil & Gas, (a W.R. Berkley Company) is an insurance underwriting manager providing unique property and casualty products and risk services to customers engaged in the energy sector. Our customers recognize the importance of the expertise we provide and appreciate the opportunity to work with professionals who understand their business. We are in turn committed to delivering innovative products and exceptional service to them, our valued agents and brokers, Berkley Oil & Gas is dedicated in its efforts to be well-informed of the changing dynamics of the industry; support industry efforts to minimize and mitigate risks and hazards in the ‘oil patch', and to constantly seek ways to improve our products and services to meet customer needs. Company URL: *************************** The company is an equal opportunity employer. Responsibilities The Technical Claims Specialist position will be responsible for handling, negotiating and resolving first and third party commercial general liability, property, Inland Marine and automobile bodily injury and property damage claims to conclusion. This position may also handle worker's compensation claims. This would include coverage verification, policy interpretation, contract interpretation, liability investigation and evaluation and negotiation of claims consistent with company policies and state regulations. Conduct and manage the investigative process, while demonstrating ongoing communication with the customer and relevant internal and external parties. Documenting files to include all key activities, contacts made, statements taken, including a full outline covering all aspect of the claim requirements for resolution. Demonstrate understanding of medical terms, medical treatment and injury descriptions. Recognition and evaluation of potential damages related to injuries. Manage the claim authorization process. Conduct complete investigation of losses through appropriate techniques including interviews, recorded statements, documentation/data gathering and securing/preserving evidence. Evaluate compensability and exposure; identify subrogation opportunities or suspicious claims. Prepare timely, concise reports and state filings as required by the jurisdiction. Promptly establish and maintain accurate reserves. Adhere to state regulatory compliance requirements. Verify, analyze, and correctly apply coverage. Develop strategy and negotiate claims to a timely conclusion, properly applying state compliance and company policies and procedures. Develop a resolution plan (e.g. pay, deny, dispute) based upon analysis of the facts, defenses, compensability, and statutory/case law. Keep policyholders, underwriting and agents advised of file status and other matters as required. Participation in presentations, meetings, or visits to agents, policyholders, prospective accounts and other groups related to claims resolution, service or technical issues. Successfully complete relevant continuing education as required. Qualifications Minimum of 7 years of multi-line experience Must possess a current Texas claims adjuster licenses; additional licenses a plus. Multi-jurisdictional experience preferred. Familiarity with Contractual Risk Transfer concepts and anti-indemnity laws Ability to follow detailed procedures and ensure accuracy in documentation and data. Excellent written and verbal communications; with ability to listen well. Recognizes differences in opinions and misunderstandings and encourages open discussion while working towards resolution. Accepts individual responsibility for all actions taken. Holds self and others accountable to the organization and stakeholders. Excellent organizational skills; ability to prioritize workload Ability to think critically and solve problems, including the ability to interpret related documentation Strong negotiation skills leading to best claim outcomes Demonstrate proficiency in computer programs, such as Microsoft Word, Outlook and Excel Education Requirement Bachelor's Degree required or equivalent work experience. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $90,000 - $140,000 • Eligible to participate in annual discretionary bonus. • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. 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. The application window for this role is estimated to be open through January 30, 2026, but may be extended, if necessary, please submit your application as soon as possible prior to January 30, 2026. Sponsorship Details Sponsorship not Offered for this Role
$90k-140k yearly Auto-Apply 60d+ ago
Paralegal/Claims Specialist
Sundt Construction 4.8
Claim processor job in Irving, TX
As a 100% employee-owned contractor, when you work at Sundt, you're not just hiring on at a company, you're joining a culture. Because everyone at Sundt is part owner, you'll join a team of people who are deeply invested in their work. From apprentices to managers, we're passionate about the details and deliberate in everything we do. At Sundt we focus on building long-term prosperity for our clients, communities, and employee-owners. We offer competitive pay, industry-leading benefits including a 401k and employee stock ownership plan, incentive programs for craft and administrative employees as well as training that focuses on your personal and professional growth. We're driven by skill, grit and purpose. Join us as we strive to be the most skilled builder in America. Job Summary The Paralegal / Claims Specialist supports the company's Legal and Risk Management functions by assisting attorneys and insurance professionals in the investigation, evaluation, and resolution of claims and lawsuits. The role involves direct collaboration with outside counsel, insurance adjusters, and internal Safety and Operations teams. The Paralegal/Claims Specialist will independently manage the day-to-day handling of routine litigation and claims matters, including discovery, documentation, and coordination with defense counsel. Key Responsibilities 1. Assists attorneys with trial preparation, exhibits, witness coordination, and logistics. 2. Assists company attorneys with responding to non-party subpoenas and regulatory inquiries. 3. Attends mediations, depositions, and hearings as appropriate to support counsel, our internal personnel and maintain awareness of case progress. 4. Communicates directly with claimants, witnesses, experts, and internal personnel to obtain and analyze relevant information, including managing internal electronic data preservation in coordination with IT team, and oversee transfer of preserved data for discovery. 5. Coordinates with Safety personnel regarding incident intake, documentation, and potential claims escalation. 6. Drafts and edits legal documents including correspondence, discovery requests and responses, routine pleadings, affidavits, and case summaries. 7. In conjunction with attorneys, manages litigation, including coordinating discovery and e-discovery, tracking deadlines, managing document production, approving and processing legal invoices and maintaining organized case files. 8. Maintains accurate and up-to-date records in Risk Information Management Systems {RIMS) or other claims databases. 9. Reviews and analyzes claims in coordination with legal and risk management professionals determine liability, damages, and insurance coverage. 10. Works closely with company attorneys, outside counsel, and insurance adjusters to investigate, evaluate, and resolve claims and lawsuits. Minimum Job Requirements 1. 5-10 Years of Experience 2. Bachelor's degree 3. Knowledge working for a law firm or an insurance company representing clients in responding to claims and lawsuit preferred. 4. Paralegal certification Note: is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 50Ibs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Note: Job Description is subject to change at any time and may include other duties as assigned. Physical Requirements 1. May stoop, kneel, or bend, on an occasional basis 2. Must be able to comply with all safety standards and procedures 3. Required to use hands to grasp, lift, handle, carry or feel objects on a frequent basis 4. Will interact with people and technology frequently during a shift/work day 5. Will lift, push or pull objects up to 501bs on an occasional basis. 6. Will sit, stand or walk short distances for up to the entire duration of a shift/work day. 7. Will use telephone, computer system, email, and other electronic devices on a frequent basis to communicate with internal and external customers or vendors Equal Opportunity Employer Statement: Sundt is committed to the equal treatment of all employees, and/or applicants for employment, and prohibits discrimination based on race, religion, sex (including pregnancy), sexual orientation, gender identity, color, age, disability, national origin, covered veteran status, genetic information; or any other classification protected by applicable Federal, state, or local laws. Benefit list: Market Competitive Salary (paid weekly) Bonus Eligibility based on company, group, and individual performance Employee Stock Ownership Plan & 401K Industry Leading Health Coverage Starting Your First Day Flexible Time Off (FTO) Medical, Health Savings, and Wellness credits Flexible Spending Accounts Employee Assistance Program Workplace Wellness Programs Mental Health Program Life and Disability Insurance Employee-Owner Perks Educational Assistance Sundt Foundation - Charitable Employee-Owner's program #LI-KA1
$45k-61k yearly est. Auto-Apply 19d ago
Claims Processing Specialist
Saferide Health
Claim processor job in San Antonio, TX
Job DescriptionSalary: SafeRide Health is looking for a hands-on Claims Specialist to scale SafeRide. We are looking for a leader with deep experience managing Medicare and Medicaid programs as we scale past $100M in annual revenue. The Billing Specialist is responsible for elevating SafeRides billing function and continuously enhancing the effectiveness of the organization. Strong business and financial orientation as well as a passion for growth and development are critical for this role. Responsibilities: Facilitates data processing and processes claims for NEMT and GMR rides. Performs reconciliation of billing data to encounter data. Works closely with the operations team to resolve issues. Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations. Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines. Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner. Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules. Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team. Served as the Billing teams subject matter expert and primary contact for claims related projects and critical activities. Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues. Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas). Champion and reinforce SafeRides culture. Required Education/Experience: Minimum 1 years of experience in billing/claims management Must be bilingual Spanish Speaking Preferred NEMT/transportation background preferred Knowledge of CMS/HHSC regulations preferred Skills Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc. Self-starter, ability to work independently and in a team environment. Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions Ability to adapt to unforeseen circumstances quickly Keen attention to detail Ability to work with a variety of stakeholders What we offer you An inclusive, encouraging and collaborative company culture Strong support for career growth, including access to our investor communities Competitive compensation with upside for growth (including stock options and performance grants) Competitive benefits including health/vision/dental insurance, 401k match and 18 days PTO About SafeRide Health: SafeRides mission is to restore access and dignity to care. SafeRide is transforming access to care for the nations sick, poor and underserved. We are a high growth, tech enabled services firm thats growing past 400 employees. SafeRide is backed by premier investors like NEA and clients like Fresenius. We operate nationally and now deliver over 5M rides per year. Learn more at ***********************
$27k-36k yearly est. 16d ago

Learn more about claim processor jobs

Do you work as a claim processor?

What are the top employers for claim processor in TX?

NTT Data International L.L.C.

Partnered Staffing

Collectivehealth, Inc.

CRC Insurance Services Inc

Top 10 Claim Processor companies in TX

NTT Data International L.L.C.
Partnered Staffing
Sedgwick LLP
NTT Europe Ltd
Mercury Insurance
Markel
Collectivehealth, Inc.
CRC Insurance Services Inc
Texas Children's Hospital
PNMAC Holdings, Inc.

Job type you want

Full Time

Part Time

Internship

Temporary

Claim processor jobs in Texas

Claims Supervisor (Bodily Injury)

Legal Claims Analyst

Technical Claims Specialist

Claims Processor

Insurance Claims Specialist

Claims Specialist - Auto

Risk Claims Specialist

General Liability Claims Specialist

Paralegal/Claims Specialist

Complex Claims Specialist

Claims Specialist III

Auto Claims Specialist

Claim Specialist Clerk

Claims Processing Specialist

Pharmacy Claims Adjudication Specialist

Claims Specialist

Mortgage Claims Processor

Technical Claims Specialist

Paralegal/Claims Specialist

Claims Processing Specialist

Learn more about claim processor jobs

Do you work as a claim processor?

What are the top employers for claim processor in TX?

Top 10 Claim Processor companies in TX

NTT Data International L.L.C.

Partnered Staffing

Sedgwick LLP

NTT Europe Ltd

Mercury Insurance

Markel

Collectivehealth, Inc.

CRC Insurance Services Inc

Texas Children's Hospital

PNMAC Holdings, Inc.

Browse claim processor jobs in texas by city

All claim processor jobs

Jobs in Texas