Claim processor jobs in Vacaville, CA - 170 jobs

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor's degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM. Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims. Duties and Responsibilities Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards. Prepare accurate and timely issuance of benefits notices and required reports within statutory limits. Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits. Ensure timely payment of benefits, bills and appropriate caseload and performance goals. Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data. Monitor, report, and assign claims for fraud potential and subrogation possibilities. Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws. Prepare and present claims summaries to clients during file reviews. Train and direct Claims Assistants to meet goals and deadlines. Review and approve priority payments and other documents from Claims Assistants. Performs other duties as assigned Knowledge, Skills, and Abilities Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions. Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits. Strong skills with use of general office administration technology, including Microsoft Office Suite and related software Excellent verbal and written communication skills Excellent interpersonal and conflict resolution skills Excellent organizational skills and attention to detail Excellent interpersonal, negotiation, and conflict resolution skills Strong analytical and problem-solving skills Ability to act with integrity, professionalism, and confidentiality, at all times The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits. #J-18808-Ljbffr

About the Company For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss. About the Role The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports. This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role. Key Responsibilities Case Management & Communication Receive, review, and manage assigned cases from start to completion. Communicate professionally with clients, claimants, witnesses, and other involved parties. Provide timely case updates and correspondence in accordance with company guidelines via CaseLink. Maintain objectivity and professionalism in all interactions. Investigative Field Work Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings. Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires. Perform scene and neighborhood canvasses, including walking on varied terrain. Meet with treating physicians and medical offices as required. Travel to designated locations, including overnight stays when necessary. Respond to rush cases within business hours when required. Documentation & Reporting Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis. Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired. Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements. Prepare and submit comprehensive investigative reports within 72 hours of final update submission. Evidence & Records Handling Retrieve records from agencies and entities both in-person and remotely. Take clear photographs and video when necessary and label all electronic files accurately. Securely collect, store, and maintain custody of evidence when required. Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure. Additional Responsibilities Identify and recommend additional investigative services outside the scope of the original assignment when appropriate. Work overtime as needed to meet case demands and deadlines. Maintain an efficient, safe, and organized telecommuter workspace. Physical & Work Environment Requirements Ability to sit for extended periods performing computer-based work and report writing. Ability to stand for extended periods while conducting interviews and canvasses. Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment). Ability to operate digital audio recording equipment. Qualifications Experience with workers' compensation claims and investigative processes. Strong written and verbal communication skills. Ability to work independently, manage time effectively, and meet strict deadlines. Willingness and ability to travel up to (but not limited to) 150 miles per assignment. Possession of a personal credit card with available balance for reimbursable business expenses. Proficiency with case management systems; CaseLink experience preferred. Access to a personal scanner for document upload and record handling. Preferred Qualifications Prior experience conducting recorded statements and field investigations. Experience with process service assignments. Familiarity with evidence handling and documentation standards. Background in insurance investigations or a related field.

Please make sure that you complete all the questions and navigate to the end of the application to sign the application. This position is a hybrid This will be a permanent Floating Examiner position to cover open desks due to Vacations, Leaves of Absence, new business onboarding, increased pending inventories, Auditing, etc. At the Direction of the Claims Supervisor and/or Manager, under minimal supervision, manages all aspects of Workers' Compensation claims (complex, litigated, non-disabling) claims from inception to conclusion within established authority and guidelines. The position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, nurses and Vocational Case Managers, and other TRISTAR staff. DUTIES AND RESPONSIBILITIES: Effectively manages a Temporary caseload of Workers' Compensation claim files, including very complex and litigated claims. * Initiates and conducts investigations in a timely manner. * Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling. * Manages medical treatment and medical billing, authorizing as appropriate. * Refers cases to outside defense counsel and participates in litigated matters. * Communicate with claimants, attorneys, providers and vendors regarding claims issues. * Work in an organized and proactive manner. * Computes and set reserves within Company guidelines. * Settles and/or finalize all claims and obtains authority as designated. * Maintains a diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action. * Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns. * Conducts file reviews as scheduled by the client and management.* Identify and review claims for Apportionment assignment. * Identify and investigate subrogation potential and pursue recovery.* Identify claim standard criteria for excess reporting and reimbursement.* Assist with State Audit and reporting responses.* Mentors less experienced Examiners Other duties as assigned and including claims management of other jurisdictional workers' comp claims. Adheres to all TRISTAR company policies and procedures. * Essential job function. EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire Qualifications QUALIFICATIONS REQUIRED: Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff. Ability to interact with people at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: California Self-Insurance Certificate Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems, several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify): Signatures: This job description has been approved by all levels of management: Human Resources: ____________________________Manager/Supervisor: _______________________________ The employee's signature below constitutes the employee's understanding of the mental and physical requirements, essential functions, and duties of the position. Employee____________________________________ Date_________________________

WHAT WE'RE LOOKING FORAre you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Are you a Spanish speaker looking to apply those skills in a professional environment? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster. Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity. RESPONSIBILITIES Completes classroom training introducing workers' compensation claims handling strategies, medical terminology, and legal concepts. Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records. Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls. Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines. Develops and updates a plan of action for the successful resolution of each claim. Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently. Reduces fraud through early identification and escalation. Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers. Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims. Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim. WHAT YOU'D BRING TO THE ROLE Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred Exceptional interpersonal and customer service skills Ability to manage and prioritize multiple assignments in a fast-paced environment Strong organization skills to ensure tasks are completed within hard deadlines Basic mathematical skills to calculate monetary reserves To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications and be proficient, or able to become proficient, on applicable databases, systems, and vendor software programs. WHY YOU SHOULD APPLY Unparalleled financial strength and stability Fantastic growth and advancement opportunities WFH Hybrid schedule Free gym in building Generous Paid Time Off and Holidays Excellent Benefits (Medical, Dental, Vision, 401k, etc) Health and Wellness Reimbursement Tuition Assistance Reimbursement Discounts across companies such as GEICO, See's Candies, etc. In accordance with the California Equal Pay Act, the starting hourly wage for this job is $32.6924. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.

DETAILS Assistant Claims Examiner - Flex Department: Workers' Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 6 Career Ladder: Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers' Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. Answer questions over the phone from medical providers regarding bills Contact treating physician for disability status Contact employer for return-to-work status or availability of modified work. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators Complete preparation of documents for overnight delivery Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners Contact with clients, injured workers, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required 2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferred Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses Administrators Certificate from Self-Insurance Plans preferred Knowledge of workers compensation laws, policies, and procedures Understanding of medical and legal terminology Must demonstrate accuracy and thoroughness in work product Ability to sit for prolonged periods of time Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good! Grow Your Skills, Grow Your Potential Responsibilities Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accident and weather-related claims for homeowners, commercial properties, and large losses. We are looking for an experienced and highly skilled professional to contribute to our dynamic team. You will be the first point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process while providing Remarkable service. Key Responsibilities: Conduct on-site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions Provide exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally Gather necessary evidence, document findings, and prepare detailed reports to support the claims handling process Investigate and adjust both personal and commercial property claims with exposures up to $500,000 Evaluate coverage and policy terms to determine the validity of claims and ensure compliance with local regulations Negotiate and settle claims within the authorized limits, considering policy provisions, industry standards, and company guidelines Where you'll work: This position is located in East Bay Area, CA. Competitive candidates should reside within one of the listed zip codes and will service this same territory: 94501, 94502, 94505, 94506, 94507, 94509, 94511, 94513, 94514, 94516, 94517, 94518, 94519, 94520, 94521, 94523, 94525, 94526, 94528, 94530, 94531, 94541, 94542, 94546, 94547, 94548, 94549, 94553, 94556, 94561, 94563, 94564, 94565, 94569, 94572, 94575, 94577, 94578, 94579, 94580, 94583, 94595, 94596, 94597, 94598, 94601, 94602, 94603, 94605, 94606, 94607, 94608, 94609, 94610, 94611, 94612, 94613, 94618, 94619, 94621, 94702, 94703, 94704, 94705, 94706, 94707, 94708, 94709, 94710, 94720, 94801, 94803, 94804, 94805, 94806, 94850, 95202, 95203, 95204, 95205, 95206, 95211, 95219, 95231, 95330. This is a Remote-Field position in which you will work from home and utilize a mobile office/vehicle for in-person appointments. Although the primary work location is in the field, with a commutable distance from home, there will be opportunities for virtual work to be completed at home. Additionally, there may be occasions where you will be required to travel outside your assigned area to assist in other territories. Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible schedules and may be asked to work overtime and/or irregular hours. Qualifications Competitive candidates must demonstrate: Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims Strong knowledge of property insurance policies, coverage and claim handling practices Knowledge of both residential and commercial building construction Familiarity with local regulations and compliance requirements in your assigned territory Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus Proven ability to assess damages, estimate repair costs, and negotiate settlements Detail-oriented with strong organizational and analytical skills Proficient in using claims management software and other relevant tools Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces May be required to complete Rope and Harness Safety Training. A valid driver's license is required Preferred: Bachelor's Degree in a related field or equivalent work experience Experience in handling complex or high-value claims Construction background Water mitigation inspection experience Xactimate, XactContents Additional Details: Employees must successfully complete all required training, including applicable licensing exam(s) and background checks required of various state(s). State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing For San Francisco candidates: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Our Benefits Because work-life balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! Potential starting salary range: $73,824.56 - $118,245.00 / annually Starting salary will be based on skills, background, and experience High end of the range limited to applicants with significant relevant experience Potential yearly incentive pay up to 15% of base salary At State Farm, we offer more than just a paycheck. Check out our suite of benefits designed to give you the flexibility you need to take care of you and your family! Get Paid! On top of our competitive pay, you are eligible for an annual raise and bonus. Stay Well! Focus on you and your family's health with our robust health and wellbeing programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare plan options, including a high deductible plan. All medical plans provide 100% coverage for in-network preventative care, AND you and your family have access to vision, dental, telemedicine, 24/7 mental health professionals, and much more! Develop and Grow! Take advantage of educational benefits like industry leading training programs, top-notch tuition assistance programs, employee resource groups, and mentoring. Plan Ahead! Plan for those big moments in life with benefits like fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and more. You can also start a savings account or consider financing through our State Farm Federal Credit Union! Take a Little “You” Time! You will have access to our generous time off policies designed so you can plan around holidays, family events, volunteering, or just to take a relaxing day off. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! Give Back! We offer several ways to give back through our Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund. Finish Strong! Plan for retirement using free financial advisors and a 401(k) plan with company contributions of up to 7% of your salary. Visit our State Farm Careers page for more information on our benefits, locations, and the hiring process of joining the State Farm team! #LI-DS3 PandoLogic. Category:Insurance, Keywords:Insurance Examiner, Location:San Leandro, CA-94577

Are you ready to make a real difference in healthcare? MIEC is searching for a dynamic Claims professional to join our passionate team and play a pivotal role in protecting medical professionals and advancing patient safety! Whether you step into the role of Claims Analyst or take on the expanded responsibilities of Claims & Patient Safety Specialist, you'll be at the heart of our mission-opening, investigating, managing, and resolving incident and claim files for our valued policyholders. But that's just the beginning! As an Analyst or Specialist in our Claims Department, you'll go beyond claims management, partnering directly with groups and individual policyholders to deliver innovative Patient Safety & Risk Management services. You'll help shape safer healthcare environments, drive impactful change, and become a trusted advisor to those who count on us most. Join MIEC and be part of a team that's redefining excellence in claims and patient safety-where your expertise, initiative, and commitment truly matter. Get a sneak peek into MIEC's mission-driven, collaborative culture by following this link. LOCATION: This position is remote, with a preference for candidates located in Southern California, with limited travel to our main office in Oakland, CA. This position requires some travel from time to time, including overnight stays. COMPENSATION: The hiring salary range of $73,050 to $149,484 will be based on role, experience, and location. Priority will be given to candidates in Southern California, but see hiring ranges below for all locations: * Hiring range for Claims Analyst role: * San Francisco Bay Area and Hawaii: $84,519 to $112,691 * All other locations: $73,050 to $97,400 * Hiring range for Claims & Patient Safety Specialist role: * San Francisco Bay Area and Hawaii: $112,113 to $149,484 * All other locations: $96,900 to $129,200 MIEC offers competitive compensation, commensurate with experience and a comprehensive benefits package. MIEC is an EEO employer; we enjoy diversity in our staff, policyholders and business partners. BENEFITS: * 401(K) + Pension Plan * Health Insurance * Vision and Dental Insurance * Generous Paid Time Off Plans WHAT YOU'LL DO: Whether hired as a Claims Analyst or a Claims & Patient Safety Specialist, your primary duties will be in Claims, where you will: * Respond to first notice of potential claims from policyholders and handle advice calls, gathering preliminary information and providing appropriate advice for action. * Collaborate with the Claims team to identify and evaluate insurance coverage issues, and to develop, prepare and implement appropriate negotiation/case resolution strategies. * Obtain and review records, interrogatories, depositions, consultant reports, and attorney reports; coordinate discovery with defense counsel; monitor file status, reserves, legal landmarks and billings. * Prepare documentation, reports, and correspondence with policyholders, claimants and attorneys. * Submit incident, claim and suit files for opening; manage and close files in a timely manner. * Exercise strong judgment in settling cases within authority and develop indemnity and expense reserve recommendations above defined authority level. * Study trends and current developments within the medical malpractice industry in the states in which MIEC operates, and nationally. Proactively share information within the department about the trends and current developments, including relevant court cases. * Participate in seminars, trainings, meetings, and Board meetings, when requested. If hired as a Claims & Patient Safety Specialist, you will also: * Collaborate with MIEC's Patient Safety & Risk Management (PSRM) staff to provide specialized internal and external services addressing existing member groups and new business, including large medical groups and hospitals. * Apply principles of healthcare risk management, such as incident reporting and investigation, risk analyses, and policies/procedures, to further develop PSRM services which can be applied in all healthcare settings. * Collect, analyze, and compare MIEC data to present evidence-based information to members, utilizing data from various healthcare and medical malpractice claims sources including Candello - Solutions by CRICO, the MPL Association Data Sharing Project, and Preverity. * Coordinate and conduct Claims Prevention Surveys for policyholders. * Manage active matters involving unanticipated patient harm through MIEC's RESTORE communication and resolution program; work with MIEC policyholders to support effective patient communication, disclosure, and/or apology discussions. * Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials. * Participate in the conception and completion of special projects. Requirements WHO YOU ARE: * An experienced team member with a demonstrated expertise in the handling of medical malpractice claims and a solid understanding of Patient Safety Risk Management (PSRM) services and products, and the ability to address general PSRM questions or refer to the appropriate discipline. * A flexible collaborator who has a demonstrated customer service focus with all levels of internal and external stakeholders. * An enthusiastic and self-directed contributor who is skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines. * An inquisitive analytical thinker with good judgement, professional initiative, and strong research skills. * An excellent communicator, with strong written, verbal, and interpersonal communication skills and ideally with proficiency in medical terminology. Additionally, a candidate hired for the Claims & Patient Safety Specialist role would need: * An understanding of clinical systems. * Knowledge of hospital policies and procedures, and governmental healthcare regulations. * Ability to analyze medical records and quality issues. WHAT YOU'LL BRING: Education: * A Bachelor's degree (BA/BS) is required. Licenses/Certification: * A valid driver's license is required. * A Certified Professional in Healthcare Risk Management (CPHRM) designation is preferred. Experience: The ideal Claims & Patient Safety Specialist candidate will join us with a minimum of seven (7) years of experience as a medical professional liability claims representative, risk manager or similar experience in defense of medical professional liability or risk management/patient safety field required. The ideal Claims Analyst candidate will join us with a minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry. Digital Skillsets: Our ideal candidate will be a digitally fluent contributor, comfortable in a range of virtual environments and proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs. About MIEC: MIEC was founded in 1975 in the depths of the malpractice crisis by physicians and their medical societies when insurance was largely unavailable to the healthcare community. As the West's first truly physician-owned medical professional liability insurer, MIEC has always been guided by the desire to protect physicians and other healthcare professionals from malpractice risks and committed to a long-term philosophy of business conduct that ensures such a crisis never happens again. We exist to foster enduring partnerships within the healthcare community by serving members through a philosophy of vigorous protection and high value, delivered by people who care. As a member-owned exchange Headquartered in Oakland, CA, MIEC now insures more than 7,400 physicians and other healthcare professionals in 4 states, with regional claims offices in Idaho, Alaska, and Hawaii. MIEC has consistently adapted to meet the changing needs of healthcare delivery and continually seeks to reinvent medical professional liability through effective partnership, innovative insights, and dynamic risk solutions.

About Stand Stand is a new technology and insurance company revolutionizing how society assesses, mitigates, and adapts to climate risks. Our leadership team has extensive experience in insurance, technology, and climate science: building billions in market value at prior ventures. At Stand, we are rethinking how insurance enables proactive, science-driven resilience. Existing insurance models often rely on broad exclusions, leaving homeowners without options. At Stand, we leverage advanced deterministic models and cutting-edge analytics to provide personalized risk assessments-helping homeowners secure coverage and take proactive steps toward resilience. Why Join Stand: At Stand, you'll join a mission-driven team redefining insurance through the lens of climate resilience, building a transformative, data-driven insurance model with real-world impact for homeowners and communities on the front lines of climate change Location: This role is onsite at either or Tampa, FL office or our San Francisco, HQ. Both are options. Role Summary: As Head of Claims at Stand Insurance, you will be responsible for managing the Claims lifecycle, end-to-end in conjunction with third party partners and the Operations team. Unlike many Claims roles, however, this role is unique in that it also provides an opportunity to be part of the solution in avoiding claims before they happen by working with mitigation and retrofitting vendors. By being involved in the building process before, during, and after a claim, you will be able to ensure we are fulfilling our promise of security to insureds in every facet. This role is great for a high energy, execution focused individual with experience in the most challenging property catastrophe markets. Core Responsibilities: Implement catastrophe response program and strategy for various catastrophe perils in conjunction with TPA partners Build core networks for programs such as water remediation, salvage and subrogation, legal defense, and other approved/recommended contractors that can provide high quality repairs for insureds while managing claim expense Maintain Claims compliance in all states and in all functional areas, such as claims handling practices, reporting, OFAC and CMS Medicare compliance, etc. Develop internal and external staffing, partnerships, and scaling Claims department for expansion of states and products Collaborate with cross-functional teams, including underwriting, product, and actuarial, to collaborate on policy language, underwriting guidelines, and claim reserving practices Help develop best in class wind mitigation vendor networks to help support insureds securing appropriate retrofitting quickly and affordably Work with Product and Technology teams to enhance technology for streamlined claim handling processes and create a seamless and transparent claim experience for insureds Must-Haves 15+ years of property claims experience, predominantly in the personal lines space High-value Homeowners experience Experience in the Florida marketplace is strongly preferred, but generally shall have experience in one or more CATs in a leadership role Comfort working cross-functionally in a fast-paced, entrepreneurial environment Nice-to-Haves Wildfire catastrophe experience Technical competencies and background in designing/working with teams to develop Claims Management software Compensation: The annual base salary range for full-time employees in this position is $150,000 to $210,000+ meaningful Equity Grant. Compensation decisions are dependent on several factors including, but not limited to, an individual's qualifications, location where the role is to be performed, internal equity, and alignment with market data. Additional Benefits: Comprehensive benefits including above-market Health, Dental, Vision Weekly lunch stipend Flexible time off 1-day a week WFH flexibility 401k plan Equal Opportunity Employment Stand is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status. We believe that diversity enriches the workplace, and we are committed to growing our team with the most talented and passionate people from every community. We are committed to providing reasonable accommodations for qualified individuals. If you require assistance Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Workers' Compensation Claim Supervisor Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 adjusters Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a Workers' Compensation Claim Supervisor with California jurisdiction expertise to remotely lead a team of adjusters out of our Las Vegas, NV branch. This role is critical in ensuring claims are handled accurately, efficiently, and in compliance with client and regulatory requirements. You'll provide clear guidance and direction throughout the lifecycle of each claim, while mentoring and developing your team for long-term success. Responsibilities • Oversee proper handling of WC claims to protect the interests of the adjuster, client, and carrier • Review claim files regularly and provide direction on complex or litigated matters • Assist with reserve accuracy and compliance with client handling instructions • Participate in claim reviews and ensure adherence to jurisdictional laws and best practices • Recruit, train, and mentor staff; conduct performance reviews and manage PIPs • Address personnel issues and manage administrative responsibilities • Ensure compliance with carrier/state reporting requirements Qualifications What You'll Bring Required: • 10+ years of WC claims experience (California jurisdiction) • Prior experience adjusting WC claims from start to resolution • CA SIP designation or CA Claims Certificate (or ability to obtain within 60 days) • Strong leadership, communication, and organizational skills Preferred: • 3+ years of supervisory experience • Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required. • Proficiency in Microsoft Office and claims systems Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

Title: Customer Service Claims Processor Department: Customer Service The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *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 of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Title: Customer Service Claims Processor Department: Customer Service Union: OPEIU 29 Grade: 17 The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *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 of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

We are looking for an experienced Insurance Claims Examiner to join our team on a contract basis in Oakland, California. In this role, you will analyze and process medical claims, ensuring accuracy and compliance with healthcare regulations. Ideal candidates will have a strong background in insurance claims management and coding, along with the ability to work independently in a fast-paced environment. Responsibilities: - Review and adjudicate medical claims for accuracy and compliance with Medi-Cal, Medicare, and other healthcare regulations. - Research and resolve claim discrepancies, ensuring proper payment and documentation. - Utilize coding systems such as ICD-10, CPT, and HCPCS to verify claim accuracy. - Maintain confidentiality while handling sensitive participant and family information. - Follow organizational policies and procedures to ensure compliance and attention to detail. - Exhibit consistent attendance and punctuality while meeting deadlines. - Communicate effectively with internal teams and external stakeholders to address claim issues. - Input accurate data into various computer systems and software programs. - Provide courteous and detail-oriented customer service to all stakeholders. - Perform additional duties as assigned to support claims processing activities. If you are interested in this role please apply now and call us at (510) 470-7450, it is an urgent need for our client. Requirements - Comprehensive understanding of medical coding systems, including ICD-10, CPT, and HCPCS. - Minimum of 3 years of claims processing experience in a Medicare/Medi-Cal environment. - Proficiency in computer applications such as Outlook, Excel, and Word. - Ability to work effectively in a multidisciplinary setting. - High school diploma required; bachelor's degree preferred. - Strong auditing, billing, and claim administration skills. - Familiarity with CMS platforms and 3M systems. - Excellent organizational and communication skills, with the ability to prioritize tasks and meet deadlines. TalentMatch Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use (https://www.roberthalf.com/us/en/terms) and Privacy Notice (https://www.roberthalf.com/us/en/privacy) .

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Major Claims Examiner is responsible for managing complex, high-value workers' compensation claims and ensuring timely, fair resolution in compliance with policy provisions while reducing financial exposure and supporting injured workers' recovery. This position manages assigned major loss claims independently while adhering to company standards and state regulations. ESSENTIAL DUTIES AND RESPONSIBILITIES Investigates and gathers necessary information to resolve assigned claims. Examines major and catastrophic claims to determine coverage, liability, and damages. Communicates with insureds to obtain information necessary for processing claims. Partners with legal counsel on litigation strategies while maintaining file ownership. Attends depositions and conferences exercising appropriate prioritization based on workload. Contacts and/or interview claimants, doctors, medical specialists, or employers to obtain relevant information. Conducts thorough investigations, including reviewing medical records, legal documents, and other supporting evidence. Directs additional investigation of questionable claims to determine compensability. Identifies potential fraud indicators and escalate as necessary. Applies technical knowledge and human relations skills to ensure fair and prompt management of cases. Manages and approves benefit payments within authority limits, ensuring compliance with state regulations and internal standards. Effectively communicates exposure and strategies to senior leadership. Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law and in accordance with company standards. Utilizes structured settlements to resolve high exposure claims. Serves as a mentor and works closely with branch staff to devise strategy for reserving and settlement on high exposure claims, as requested. Identifies opportunities to engage with other company departments including managed care, legal, payment recovery, and SIU. Attends settlement mediations and conferences, as necessary. Participates in claim reviews and service calls with insureds and prospective insureds. Reduces and mitigates Company's financial exposure. Researches historical billing data for facilities and providers to establish accurate file reserves. Analyzes and reports catastrophic and major claims loss data to WCC leaders. Implements proactive and strategic plans to bring claims to a timely and appropriate resolution. Anticipates future developments and exposures and maintain accurate reserves. Pursues subrogation in most cases; refers and/or follows up on subrogation efforts. SUPERVISORY RESPONSIBILITIES This role does not have supervisory responsibilities. EDUCATION AND EXPERIENCE Bachelor's degree in Business Administration, Management, Economics, Accounting, or related field (or equivalent combination of work experience and education). Minimum 10+ years' workers' compensation claims experience with specific experience managing and resolving major claims losses. CERTIFICATES, LICENSES, REGISTRATIONS Required to receive certification that meets the minimum standards of training, experience and skill. Maintain state Workers' Compensation License, as required. Continuing education designations (CPCU, AIC, etc.) or other industry licensing and training programs are preferred. KNOWLEDGE AND SKILLS Expert knowledge of complex claims principles and practices. Proficiency in claims handling systems, analytics tools, and databases. Strong understanding of multi-jurisdictional laws. Ability to apply technical knowledge and human relations skills to ensure fair and prompt management of cases. Skilled in negotiation, strategic decision-making, and mentoring. Advanced critical thinking skills and attention to detail. Excellent verbal and written communication skills, time management, and organizational skills required. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $90,559.93 - $152,723.07 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? Challenging work and the ability to make a difference You will have a voice and feel a sense of belonging We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match Bonus potential for all positions Paid Time Off Paid holidays throughout the calendar year Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

Who is Federated Insurance? At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own. Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values. What Will You Do? Customer-focused, source of knowledge and comfort, desire to help, professional, self-motivated - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss. No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients. This is an in-office position that will work out of our Rancho Cordova, CA office, located at 10850 Gold Center Drive. A work from home option is not available. Responsibilities Work with policyholders, attorneys, and others to ensure claims are resolved in a prompt, fair and courteous way. Explain policy coverage to policyholders and third parties. Complete thorough investigations and document facts relating to claims. Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars. Minimum Qualifications Current pursuing, or have obtained a four-year degree Experience in a customer service role in industries such as retail, hospitality, logistics, banking, equipment dealerships, equipment rental, sales or similar fields Ability to make confident decisions based on available information Strong analytical, computer, and time management skills Excellent written and verbal communication skills Leadership experience is a plus Salary Range: $63,800 - $78,000 Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. In addition, this position is eligible for a Geographic Differential Payment. Details of this benefits will be discussed in the interview process.) What We Offer We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You. Employment Practices All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization. If California Resident, please review Federated's enhanced Privacy Policy.

Sr Claim Examiner- WC 02-month contract with possible extension Remote Note: Must have multiple years'experience handling CA WC. Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted. Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. Analyzes claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. Develops subrogation and third-party recovery potential and follows reclaim procedures. Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews. Skills: Ability to work independently while assimilating various technical subjects. Strong written and oral communication, negotiation and presentation skills. Advanced analytical and problem-solving skills, with the ability to manage and prioritize multiple projects. Education: Bachelor's degree or equivalent experience required. Comprehensive claims investigations/settling experience 1-3 years'experience in Claims or similar organization

Full-time Description Summary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties. Essential Duties and Responsibilities include the following. Other duties may be assigned. · Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim. · Comprehensive understanding of employee benefits for medical, dental and vision plans. · Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims · Ensures all claims are coded properly. · Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability. · Maintains high quality standards to avoid paying claim incorrectly. · Maintains productivity standards set by Management. · Refers most questionable claims for investigation to claim examiner II for review and processing. · Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned. · Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt. · Performs other duties and responsibilities as assigned by Management. Supervisory Responsibilities: This job has no supervisory responsibilities. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Requirements Knowledge, Skills, & Abilities: Excellent written and verbal communication skills. Strong analytical skills and problem-solving skills. Must be dependable and maintain excellent attendance and punctuality Must be able to perform data entry operations quickly and accurately. Ability to grow with changing demands of the position and the company. Strong computer skills, including Word, Excel, and Outlook. Successful candidates must have experience processing medical claims for an insurance company or third party administrator Must be highly proficient in ICD-10, CPT, and HCPCS codes. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; Must have 3-5 years employee benefits industry/processing claims experience or equivalent combination of education and experience. Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations. Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record. Salary Description $21.00 - $26.00 DOE

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities Benefit interpretation and analysis of EOCs across multiple health plans Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories Analysis of authorization rules and Division of Financial Responsibility (DOFR) Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) Assist with maintenance of benefit requirements and configuration decisions and policies and procedures Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance Other duties as assigned Requirements 5+ years of experience in benefits and claims in Managed Care, delegated model setting Experience with benefit analysis and/or quality assurance College degree in healthcare (preferred) or equivalent experience/knowledge Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. Experience with Epic Tapestry (preferred) Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities Knowledge of how benefit configuration relates to claims adjudication and payment processes. Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. Experience with testing, reviewing, and validating benefit plans Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer

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 third party liability construction defect commercial claims with moderate to high complexity and exposure. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-KP1 #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 ***************************.