Claim processor jobs in Virginia

The Mortgage Servicing Default Claims Processor is responsible for the timely and accurate preparation, submission, and reconciliation of default-related claims to investors and insurers, including HUD/FHA, VA, USDA, Fannie Mae, Freddie Mac, and private mortgage insurance (MI) companies. This includes evaluating claim submissions, supporting documentation, and reimbursement processes to ensure compliance with investor/insurer guidelines and company standards. The role plays a critical part in mitigating financial risk and ensuring claim recoverability. May assist in developing and implementing policies, procedures, and training materials to maximize efficiency. This role ensures compliance with all regulatory, investor, and insurer guidelines while working to maximize recovery on defaulted loans. Primary Responsibilities include: + Prepare and submit claims for defaulted mortgage loans, including foreclosure, short sale, deed-in-lieu (DIL), and Real Estate Owned (REO). + Review loan documents, servicing notes, and timelines to ensure accuracy and completeness of claim packages. + Ensure compliance with investor/insurer guidelines and servicing timelines. + Communicate with internal departments (foreclosure, bankruptcy, loss mitigation, REO) to gather required documentation and resolve discrepancies. + Utilize servicing systems (e.g., Black Knight MSP, LPS) and investor portals (e.g., FHA Catalyst, VA Servicer Portal) to submit claims. + Monitor and track claim payments, denials, or curtailments and resolve exceptions or rejections. + Maintain accurate records for audit readiness and investor/insurer reporting. + Support internal and external audits by providing requested documentation and clarifications. + Identify process improvement opportunities to increase claim recovery efficiency. Qualifications/Required Skills/Experience: + 2 to 4 years of experience with Mortgage Servicing Operations + Knowledge of the Foreclosure, Loss Mitigation, Bankruptcy and Collection process + Ability to develop and deliver presentations. + Knowledge of business concepts as applicable to ACDC department + Ability to work independently and have strong analytic skills. + Ability to adapt procedures, processes, and techniques to the completion of assignments. + Ability to develop and prepare business analysis. + Ability to process computer data and to format and generate reports. + Able to independently apply competencies in routine and more complex situations. + Knowledge of the Investor/Insurer and MI companies reporting requirements and deadlines. + Work closely with Investor Reporting, Default Cash and Claims as well as all other Default Business lines. + Ability to manage competing priorities. + Knowledge of MSP/ LoanSphere + Advanced Microsoft office skills (Excel/Word/PowerPoint) + Knowledge of regulatory expectations, risk exposure level, compliance deficiencies audit requirements. + Knowledge of strategic analytics, enterprise-wide impacts, and concepts. + Education-Certifications and/or other professional Credentials: HS Diploma, College degree, Associates degree and/or minimum of 3 years mortgage servicing experience Hours & Work Schedule Hours per week: 40 Work Schedule: Monday- Friday 8:00am-5:00pm *This is a hybrid (4 days a week in office) after successful training period* Some job boards have started using jobseeker-reported data to estimate salary ranges for roles. If you apply and qualify for this role, a recruiter will discuss accurate pay guidance. Equal Employment Opportunity Citizens, its parent, subsidiaries, and related companies (Citizens) provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to age, ancestry, color, citizenship, physical or mental disability, perceived disability or history or record of a disability, ethnicity, gender, gender identity or expression, genetic information, genetic characteristic, marital or domestic partner status, victim of domestic violence, family status/parenthood, medical condition, military or veteran status, national origin, pregnancy/childbirth/lactation, colleague's or a dependent's reproductive health decision making, race, religion, sex, sexual orientation, or any other category protected by federal, state and/or local laws. At Citizens, we are committed to fostering an inclusive culture that enables all colleagues to bring their best selves to work every day and everyone is expected to be treated with respect and professionalism. Employment decisions are based solely on merit, qualifications, performance and capability. Why Work for Us At Citizens, you'll find a customer-centric culture built around helping our customers and giving back to our local communities. When you join our team, you are part of a supportive and collaborative workforce, with access to training and tools to accelerate your potential and maximize your career growth Background Check Any offer of employment is conditioned upon the candidate successfully passing a background check, which may include initial credit, motor vehicle record, public record, prior employment verification, and criminal background checks. Results of the background check are individually reviewed based upon legal requirements imposed by our regulators and with consideration of the nature and gravity of the background history and the job offered. Any offer of employment will include further information. 12/31/2025

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

Morton is seeking a Claims Examiner for our client in Richmond, VA. The ideal candidate will be responsible for investigating, evaluating, and settling commercial liability claims. The candidate should have experience with commercial general liability claims handling, which would include reviewing and analyzing coverage, liability and damages. Strong letter writing skills and an interest in handling other lines of business are essential. Responsibilities: Review and analyze coverage, liability and damages Write both coverage and liability position letters Conduct interviews with claimants, witnesses, and other parties involved in the claim. Hire and manage outside vendors such as independent adjusters, defense counsel and other experts as needed Prepare detailed claim reports as needed for upper management Negotiate settlements with claimants and attorneys Maintain accurate notes, records and files Qualifications: Bachelor's Degree - COMPLETED Experience working in the E&S space Experience in commercial casualty claims. Excellent written and verbal communication skills, including letter writing ability. Strong knowledge of commercial liability insurance policies, coverage analysis, and claims handling procedures. Openness to learning and handling other lines of business. Excellent communication, negotiation, and analytical skills. Ability to work independently and as part of a team.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Auto/Bodily Injury **PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. + Responsible for litigation process on litigated claims. + Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. + Reports large claims to excess carrier(s). + Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. **Skills & Knowledge** + In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

The Mortgage Servicing Default Claims Processor is responsible for the timely and accurate preparation, submission, and reconciliation of default-related claims to investors and insurers, including HUD/FHA, VA, USDA, Fannie Mae, Freddie Mac, and private mortgage insurance (MI) companies. This includes evaluating claim submissions, supporting documentation, and reimbursement processes to ensure compliance with investor/insurer guidelines and company standards. The role plays a critical part in mitigating financial risk and ensuring claim recoverability. May assist in developing and implementing policies, procedures, and training materials to maximize efficiency. This role ensures compliance with all regulatory, investor, and insurer guidelines while working to maximize recovery on defaulted loans. Primary Responsibilities include: * Prepare and submit claims for defaulted mortgage loans, including foreclosure, short sale, deed-in-lieu (DIL), and Real Estate Owned (REO). * Review loan documents, servicing notes, and timelines to ensure accuracy and completeness of claim packages. * Ensure compliance with investor/insurer guidelines and servicing timelines. * Communicate with internal departments (foreclosure, bankruptcy, loss mitigation, REO) to gather required documentation and resolve discrepancies. * Utilize servicing systems (e.g., Black Knight MSP, LPS) and investor portals (e.g., FHA Catalyst, VA Servicer Portal) to submit claims. * Monitor and track claim payments, denials, or curtailments and resolve exceptions or rejections. * Maintain accurate records for audit readiness and investor/insurer reporting. * Support internal and external audits by providing requested documentation and clarifications. * Identify process improvement opportunities to increase claim recovery efficiency. Qualifications/Required Skills/Experience: * 2 to 4 years of experience with Mortgage Servicing Operations * Knowledge of the Foreclosure, Loss Mitigation, Bankruptcy and Collection process * Ability to develop and deliver presentations. * Knowledge of business concepts as applicable to ACDC department * Ability to work independently and have strong analytic skills. * Ability to adapt procedures, processes, and techniques to the completion of assignments. * Ability to develop and prepare business analysis. * Ability to process computer data and to format and generate reports. * Able to independently apply competencies in routine and more complex situations. * Knowledge of the Investor/Insurer and MI companies reporting requirements and deadlines. * Work closely with Investor Reporting, Default Cash and Claims as well as all other Default Business lines. * Ability to manage competing priorities. * Knowledge of MSP/ LoanSphere * Advanced Microsoft office skills (Excel/Word/PowerPoint) * Knowledge of regulatory expectations, risk exposure level, compliance deficiencies audit requirements. * Knowledge of strategic analytics, enterprise-wide impacts, and concepts. * Education-Certifications and/or other professional Credentials: HS Diploma, College degree, Associates degree and/or minimum of 3 years mortgage servicing experience Hours & Work Schedule Hours per week: 40 Work Schedule: Monday- Friday 8:00am-5:00pm * This is a hybrid (4 days a week in office) after successful training period* Some job boards have started using jobseeker-reported data to estimate salary ranges for roles. If you apply and qualify for this role, a recruiter will discuss accurate pay guidance. Equal Employment Opportunity Citizens, its parent, subsidiaries, and related companies (Citizens) provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to age, ancestry, color, citizenship, physical or mental disability, perceived disability or history or record of a disability, ethnicity, gender, gender identity or expression, genetic information, genetic characteristic, marital or domestic partner status, victim of domestic violence, family status/parenthood, medical condition, military or veteran status, national origin, pregnancy/childbirth/lactation, colleague's or a dependent's reproductive health decision making, race, religion, sex, sexual orientation, or any other category protected by federal, state and/or local laws. At Citizens, we are committed to fostering an inclusive culture that enables all colleagues to bring their best selves to work every day and everyone is expected to be treated with respect and professionalism. Employment decisions are based solely on merit, qualifications, performance and capability. Background Check Any offer of employment is conditioned upon the candidate successfully passing a background check, which may include initial credit, motor vehicle record, public record, prior employment verification, and criminal background checks. Results of the background check are individually reviewed based upon legal requirements imposed by our regulators and with consideration of the nature and gravity of the background history and the job offered. Any offer of employment will include further information. Benefits We offer competitive pay, comprehensive medical, dental and vision coverage, retirement benefits, maternity/paternity leave, flexible work arrangements, education reimbursement, wellness programs and more. View Benefits Awards We've Received Age-Friendly Institute's Certified Age-Friendly Employer Dave Thomas Foundation's Best Adoption-Friendly Workplace Disability:IN Best Places to Work for Disability Inclusion Human Rights Campaign Corporate Equality Index 100 Award Fair360 Top Regional Company FORTUNE's World's Most Admired Companies Military Friendly Employer

Are you graduating in 2026 - or looking to pivot your career? Kinsale Insurance is seeking motivated graduates and career changers for our Associate Claims Examiner role. This entry-level opportunity provides immediate responsibility, structured training, and long-term advancement in the insurance industry. About Kinsale Insurance Kinsale Insurance is an excess and surplus (E&S) lines insurer specializing in hard-to-place, small to medium commercial accounts. Licensed in all 50 states, we write across Property, Casualty, and Specialty lines. Our Claims team plays a critical role in delivering exceptional service and fair resolutions. What You'll Do A typical day as an Associate Claims Examiner may include: Managing a desk of low-to-moderately complex property and liability claims. Investigating and evaluating claims throughout the process. Drafting and issuing coverage correspondence to policyholders. Determining liability, evaluating exposures, and negotiating settlements. Communicating with policyholders, claimants, and other stakeholders. Maintaining accurate and complete claim documentation. Driving claims toward timely resolution. Qualifications A successful candidate has: Associate's or bachelor's degree (or relevant insurance experience). Strong written and verbal communication skills. Analytical and problem-solving ability. Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint). Organization and time management skills. Ability to collaborate in a fast-paced environment and manage multiple claims simultaneously. A compelling candidate also has: Negotiation skills with proven results. Proficiency in directing and overseeing investigations. Hiring Timeline Phone screens: October 2025 - January 2026 Interviews: January 2026 Offers extended following interviews Start dates: May, June, or July 2026 Benefits Competitive salary with performance-based bonus opportunities Health, dental, and vision insurance with company HSA contributions Short- and long-term disability coverage Life insurance Matching 401(k), fully vested immediately Generous paid time off and holidays Reimbursement for training and professional development Clear promotion paths and career advancement from within Kinsale values strong financial responsibility. A credit check will be conducted as a part of the selection process for roles that require sound judgement, trustworthiness, or access to sensitive information.

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills. Job Responsibilities Confirms coverage of claims by reviewing policies and documents submitted in support of claims. Conducts, coordinates and directs investigation into loss facts and extent of damages. Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure. Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents. Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting. Required Qualifications This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred. Must have or be eligible to receive claims adjuster license. Successful completion of basic insurance courses or achievement of industry designations. Ability to be trained in insurance adjusting up to two years of claims experience. 2-4 years of experience in general liability, construction defect, or related liability lines preferred. Bachelor's degree preferred Excellent written and oral communication skills. Strong organizational and time management skills. # LI-Hybrid US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose ‘Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

Company Details Berkley Mid-Atlantic Insurance Group is a member of W. R. Berkley Corporation, one of the largest commercial lines property casualty insurance holding companies in the United States. With the resources of a large Fortune 500 corporation and the ability to operate with the closeness and flexibility of a small company, we exclusively work with select independent agents to ensure the future of business. Company URL: *********************** The company is an equal opportunity employer. Responsibilities As a Workers' Compensation Claims Representative, you will play a critical role in maintaining these standards by providing quality claim handling and superior service to our customers, while also engaging in indemnity and expense management. Success in this position will be driven by combining your experience in Workers' Compensation claims management with excellent communication and critical reasoning. Investigate, evaluate, reserve, negotiate and resolve Workers Compensation claims in multiple jurisdictions and in accordance with Best Practices. Promptly manage claims by completing essential functions including contacts, investigations, damages development, evaluation, reserving, and disposition. Regularly handle claims involving complex coverage issues and severe injuries. Develop action plans and handle the claims from assignment to early conclusion. Review incoming mail daily, responding as needed to bring the claim to a prompt fair conclusion and seeking supervision as needed. Work closely with medical management as needed Prepare large loss reports as needed to include updated action plan and recommended reserves. Maintain a current diary on outstanding claims. Provide direction and guidance to defense attorneys and other experts while controlling expenses. Meet or exceed specific objectives for service, quality, and reserving standards and other measurable performance items. Perform other duties as assigned by the Claims Management. Qualifications 5+ years of experience in a workers' compensation claims position CPCU, SCLA or AIC designation is a plus. Working knowledge of current state and local workers' compensation laws preferred Experience in handling multiple jurisdictions is a plus Proven ability to identify and address coverage issues, complete investigations to determine exposure, set timely reserves, and develop detailed action plans. Excellent communication and negotiation skills. Computer proficiency and working knowledge of Microsoft Office products. Experience with Guidewire claims management system is a plus. 4-year college degree or equivalent work experience required. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.

Overview: As the Casualty Claims Specialist, you will be responsible for managing injury and damage claims in personal and commercial auto, as well as general liability cases. Locations: We are seeking candidates in Phoenix, AZ, O'Fallon, MO, Chesapeake, VA, Philadelphia, PA, Alpharetta, GA Key Responsibilities: Analyze initial reports to determine the nature of loss, coverage provided, and the scope of injury or damage in both personal and commercial auto, as well as general liability cases. Conduct comprehensive investigations into all aspects of reported claims, including potential fraud. Secure appropriate supporting documentation and verify its accuracy, relevance, and completeness. Manage first and third-party injury claims related to No-Fault/Med Pay and liability exposures. Apply knowledge of jurisdictional regulations and case law applicable to all territories handled. Negotiate liability and damages effectively when appropriate. Demonstrate the ability to manage and monitor cases to ensure timely development and resolution of claims inventory. Collaborate with department management to deliver presentations, conduct meetings, and serve as a technical resource. Experience & Education Requirements: 5-7+ years of experience in liability insurance claims adjusting, including litigation. Bachelor's Degree or equivalent experience. Desired Skills: Comprehensive understanding of insurance contracts, investigation techniques, legal requirements, and insurance regulations. Aptitude for evaluating, analyzing, and interpreting contracts and other complex information. Excellent verbal and written communication skills. Licensure Requirement: If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure. Company Benefits Highlights: At Chubb, we foster a collaborative in-office environment with the flexibility to support our employees' needs. Our comprehensive benefits package includes: Competitive compensation and performance-based bonuses Medical, dental, and vision coverage starting on your first day of employment Generous paid time off (PTO) 10 paid holidays each year Up to 9% 401(k) contribution from Chubb Tuition reimbursement to support your ongoing education Stock options for eligible employees We welcome enthusiastic candidates who are ready to take on the challenges of this role and contribute to our team's success!

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Job Details Salem, VA Full Time $50000.00 - $80000.00 Salary/year DayDescription LOCAL CANDIDATES ONLY POSITION IS FULL TIME IN OFFICE Our company is growing! We are seeking a Compliance Analyst with knowledge in the healthcare field. Research Data Group's Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry. This position is responsible for performing compliance reviews and appeals as relates to compliance reviews and research as necessary to determine the accuracy and appeals of the charges billed by facilities. This position will consult with the EVP of Production System, Manager of Claims Analysts and Senior Resolution Specialist. This position will assist with any special projects and/or development of edits to the Hospital Software Program. Compliance Analysis and Appeal review Receives, investigates, and responds to appeals from hospitals. Research and obtain appropriate documentation to support the appeal. Review of UB04 and detailed itemized statements Review of automated system analysis Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes. Review procedure/facility codes for unbundling, MUE's, multiple procedures, inpatient codes on outpatient bills, routine services, etc. Review of UB04 and detailed itemized statements Assist in Internal Code Creation Attend required staff training and meetings. Other special projects as needed. Medical Review and Pricing Analysis o Review medical record documentation as relates to the UB04 and itemized statement o Identify compliance and billing errors as well as make appropriate documentation as relates to review performed o Obtain hospital CMS certification information KNOWLEDGE, SKILLS & ABILITIES Two-year experience in Microsoft Office and Excel programs Proficient data entry skills and accuracy Ability to follow procedures. Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards. Exceptional attention to detail Excellent organizational, analytical, and problem-solving skill Capable of handling multiple projects in a fast-paced, hyper-growth environment Strong interpersonal and team-building skills Experience and Training 1-2 years' experience as LPN or RN preferred. Certified Professional Coder (CPC), (CPMA) (preferred but not required) One or more years of experience working with healthcare claims that demonstrate expertise in ICD 9/10 Coding, HCPCS/CPT Coding, DRG and medical billing for an Insurance company and/or hospital. One or more years of experience performing medical record reviews is required. Medical Terminology Problem-solving skills to research and resolve discrepancies, denials, appeals. Medicare Appeals processing background. (Preferred) RAC Audit experience (Preferred but not required) Knowledge of Medical fraud/abuse healthcare laws (Preferred but not required) Rev cycle management (Preferred)

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $52,600.00 - $86,800.00 Target Openings 1 What Is the Opportunity? LOCATION REQUIREMENT: This position services Insureds/Agents in and around Chantilly, Fairfax, Sterling, Manassas, Springfield, areas. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. What Will You Do? * Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. * The on the job training includes practice and execution of the following core assignments: * Handles 1st party property claims of moderate severity and complexity as assigned. * Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. * Broad scale use of innovative technologies. * Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. * Establishes timely and accurate claim and expense reserves. * Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. * Negotiates and conveys claim settlements within authority limits. * Writes denial letters, Reservation of Rights and other complex correspondence. * Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. * Meets all quality standards and expectations in accordance with the Knowledge Guides. * Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. * Manages file inventory to ensure timely resolution of cases. * Handles files in compliance with state regulations, where applicable. * Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. * Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. * Identifies and refers claims with Major Case Unit exposure to the manager. * Performs administrative functions such as expense accounts, time off reporting, etc. as required. * Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * Must secure and maintain company credit card required. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. * This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience. * Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic. * Verbal and written communication skills -Intermediate. * Attention to detail ensuring accuracy - Basic. * Ability to work in a high volume, fast paced environment managing multiple priorities - Basic. * Analytical Thinking - Basic. * Judgment/ Decision Making - Basic. * Valid passport. What is a Must Have? * High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. * Valid driver's license. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Under minimal supervision, the Claims Specialist/Executive Claims Specialist manages a caseload of high complexity commercial insurance claims focused on Allied Health (assisted living and skilled nursing facilities). The Claims Specialist will review claims to analyze land determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty. Duties and Responsibilities Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service Perform coverage, liability, and damage analysis on all claims assignments Investigate allegations, determine facts based on evidence and interviews Draft disclaimers and reservation of rights letters when coverage issues arise Assign limited investigations and appraisals to independent licensed professionals Manage a caseload of high complexity claims with delegated authority Manage litigated files Negotiate settlements, mitigate losses, and control expenses Participate in and attend mediations to facilitate settlements Maintain accurate documentation in claim files Maintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokers Act as a consultant providing technical expertise within specialty area to internal stakeholders Provide technical guidance, assistance and training as needed for less experienced Claims professionals Maintain a passing quality assurance score on all audits and QAs Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity Handle claims in accordance with established James River Claims Best Practices Other duties as required by management Knowledge, Skills and Abilities Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL) Expert level of expertise in claim handling and suit management Expert knowledge of P&C insurance industry Expert ability to effectively assess risk Proficiency in MS Office (Word, Excel, Outlook) Excellent written and verbal communication skills Advanced analytical and organizational skills Advanced negotiation skills Ability to work independently and take initiative Ability to exercise sound judgement in making critical decisions Research, analysis and problem-solving skills Ability to work in a team environment and accept feedback from Claims management Ability to build effective relationships with business partners Ability to organize complex information and pay close attention to detail Ability to anticipate customer needs and take initiative to meet those needs Ability to train and provide technical guidance to less experienced Claims professionals Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter Experience and Education Claims Specialist High school diploma required Bachelor's Degree preferred Advanced Degree or Juris Doctorate Degree preferred Minimum of seven years of experience handling primary and excess claims-made and occurrence liability policies and claims. Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills Adjuster license and/or certifications desired preferred Executive Claims Specialist High school diploma required Bachelor's Degree preferred Advanced Degree or Juris Doctorate Degree preferred Minimum of ten years of experience handling primary and excess claims-made and occurrence liability policies and claims. Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims. Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL) Project management and process implementation experience preferred #LI-KS1 #LI-Remote

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. + Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. + Performs claim re-work calculations. + Follow through completion of claim overpayments, underpayments, and any other irregularities. + Process complex non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. + Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. + Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to lesser experience staff. + Utilize all resource materials to manage job responsibilities. **Required Qualifications** + 2+ years medical claim processing experience. + Experience in a production environment. + Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. + Effective communications, organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Associate degree preferred. **Education** + High School Diploma or GED. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 12/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

MBP is looking for Claims Analyst/Lead Claims Analyst/Senior Claims Analyst * in Tampa, FL, Raleigh, NC, or Washington DC areas, with significant experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Highly proficient in Oracle P6 and experienced with one or more of the following: Microsoft Project, Phoenix Project Manager, or similar. Responsibilities Main Duties: Performs review and analysis of construction claims. Assists with development of contractor claims. Develops and/or review time extension requests. Assist with development of expert reports and exhibits. Qualifications Education B.S. in Civil Engineering, Construction Management, or relevant experience which equates to this degree. P.E. license, Certified Construction Manager, Planning and Scheduling Profession, or similar, certification preferred. Skills and Abilities Experience developing and/or providing review and analysis of construction claims, specifically related to delay, productivity, and cost impacts. Experience drafting expert reports and deliverables. Proficient in Oracle P6 required and experienced with Microsoft Project desired. Additional experience in one or more of the following desired: construction management, cost estimating, value engineering, risk management, constructibility review, and/or contract administration. Ability to relate technical knowledge to a non-technical audience. Proficiency in reading/understanding construction plans and specifications. Proficiency with Microsoft Office software programs including Word, Excel, and PowerPoint. Experience providing training, supervision, proposal development, and business development desired. Occasional overnight travel may be required. STATUS: Full-time BENEFITS: Competitive compensation with opportunities for semi-annual bonuses Generous Paid Time Off and holiday schedules 100% Employer paid medical, dental, vision, life, AD&D, and disability benefits (for individual) Health Savings Account with company contribution 401(k)/Roth 401(k) plan with company match Tuition Assistance and Student Loan Reimbursement Numerous Training and Professional Development opportunities Wellness Program & Fitness Program Reimbursement Applicants must be authorized to work in the U.S. without sponsorship. MBP is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Protected veterans and individuals with disabilities are encouraged to apply.

Job Description METIS | Location: Roanoke, VA | Full-Time Are you seeking a professional career in Roanoke? Do you like solving problems, analyzing details, and helping people? At Metis, we take a unique approach to commercial insurance through administering self-insurance Risk Pools. If you are looking for a change and a challenge, we're looking for a dedicated Property and Casualty Claims Specialist to join our growing team. What You'll Do: Manage and resolve property and casualty and/or general liability claims Assess and evaluate claims, conduct investigations, and ensure documentation is collected Build relationships with members and help claimants navigate the claims process What You Bring: Bachelor's Degree or higher - required 7+ years of experience in property and casualty claims handling Strong knowledge of policy analysis and associated legal issues A team player with excellent communication and a customer focused mindset *Please be sure to fully complete and upload the attached “Application for Employment” form along with your electronic application. Incomplete submissions may not be considered. What We Offer: Competitive compensation and performance bonuses Individual dental, life, short-term & long-term disability insurance at no cost Medical insurance with wellness incentives Health Savings Account with annual company contribution 401(k) with 200% company match up to 6% of salary Generous paid time off, including vacation, sick leave, and 11 paid holidays Support for continuing education and professional growth A beautiful campus with a collaborative, supportive, wellness-focused culture including onsite gym and café

Claims Auditor I, II and Senior Location : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Claims Auditor I is responsible for pre and post payment and adjudication audits of high dollar claims for limited lines of business, claim types and products including specialized claims with appropriate guidance from management and peers. The Claims Auditor II is responsible for audits of high dollar claims across the stop loss business, including specialized claims, working independently and without significant guidance. The Claims Auditor Senior is responsible for auditing of high dollar claims across the stop loss business, including complex specialized claims within Service Experience. Serves as the subject matter expert for the unit. How you will make an impact : * Performs audits of high dollar claims. * Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity. * Contacts others to obtain any necessary information. * Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. * Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable. * Refers overpayment opportunities to Recovery Team. * Claims Auditor II - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. * Claims Auditor Senior - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills. Minimum Requirements : * Claims Auditor I : Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background. * Claims Auditor II : Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. * Claims Auditor Senior : Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: * Stop loss claims experience highly preferred. * Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred. * Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred. * Strong research and problem solving skills preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is : Claims Auditor I $21.41 to $38.88/hr Claims Auditor II $22.54 to $40.94/hr Claims Auditor Senior $25.69 to $46.64/hr Locations: Illinois, Massachusetts, Minnesota, Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: CLM > Claims Support Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$47,700.00 - $78,600.00Target Openings1What Is the Opportunity?This is an entry level position that requires satisfactory completion of required training to advance to Claim Rep, Inside Property-Hub position. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.What Will You Do? Completes required training program which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. The on the job training includes practice and execution of the following core assignments: Handles 1st party Property claims of low to moderate severity and complexity as assigned. Establishes accurate scope of damages for building and contents losses and utilize as a basis for written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence to insureds. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations per Knowledge Guides. Maintains an effective diary system and document claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Special Investigations Unit and/or Subrogation Unit. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, WC, GL and other areas of the business as needed. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred or a minimum of 2 years of work OR customer service related experience preferred. Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic What is a Must Have? High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. 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