Claim processor jobs in Vista, CA - 53 jobs

Company Details Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company's distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company. Company URL: ********************* The company is an equal opportunity employer. Responsibilities The Workers' Compensation Examiner is responsible for the analysis and management of workers' compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. This position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. Key functions include but are not limited to: * Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. * Negotiates settlement of claims up to designated authority level and makes claims payments. * Processes complex or technically difficult claims. * Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. * Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. * Prepares necessary state filings within statutory limits. * Actively manages the litigation process; ensures timely and cost effective claims resolution. * Coordinates vendor referrals for additional investigation and/or litigation management. * Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. * Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets. * Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner. * Frequently communicates with all appropriate parties involved with the claim. * Refers cases as appropriate to management. * Maintains professional client relationships. * Actively executes appropriate claims activities to ensure consistent delivery of quality claims service. Qualifications * Baccalaureate degree from an accredited college or university preferred * Professional certification as applicable to workers' compensation required * 1-4 years claims management experience * In-depth knowledge of appropriate insurance principles and laws for workers' compensation * Strong written and verbal communication skills * Strong organizational skills * Strong negotiation skills * Strong analytical and interpretive skills * PC literate Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $70,000 - $85,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Responsibilities The Workers' Compensation Examiner is responsible for the analysis and management of workers' compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. This position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. Key functions include but are not limited to: - Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. - Negotiates settlement of claims up to designated authority level and makes claims payments. - Processes complex or technically difficult claims. - Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. - Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. - Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. - Prepares necessary state filings within statutory limits. - Actively manages the litigation process; ensures timely and cost effective claims resolution. - Coordinates vendor referrals for additional investigation and/or litigation management. - Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. - Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets. - Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner. - Frequently communicates with all appropriate parties involved with the claim. - Refers cases as appropriate to management. - Maintains professional client relationships. - Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Job Description About Us Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together. Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community. As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 90k people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants. ROLE OVERVIEW and PURPOSE The PACE Claims Processor will review, analyze, and adjudicate all contracted claims for PACE participants to ensure timely and accurate payments are distributed. This position will use technology and data to identify and resolve root causes for claims and payment errors. Additionally, this role will work collaboratively with our third-party administrator (TPA), contracted providers, specialists, participants, and other departments to ensure timely resolution of invoices and claims. RESPONSIBILITIES Conducts claim audits daily to cross-references provider contracts and assure payment accuracy on all claims received, suspended, approved, denied, posted, and paid Adjudicates and processes claims to ensure claims are allowable and have proper authorizations, including correct payment amounts, contract alignment, and current Medicare rates Analyzes payment ACH requests from our TPA to ensure claims are paid timely and accurately according to contractual agreements Processes monthly eligibility for PACE enrolled participants with Centers for Medicare & Medicaid Services (CMS) and Department of Health Care Services (DHCS) Researches and responds to customer inquiries, concerns or requests for EOP's throughout the life of a claim in a timely manner to ensure customer satisfaction and retention Understands and interprets Medicare and Medi-Cal fee schedules Works collaboratively with TPA to ensure risk adjustments, encounter data submissions, and accounts receivables are completed in a timely manner Assists in maintaining and developing claim policies and procedures Works closely with PACE Accounting to ensure data accuracy for financial reporting Maintains professional working relationships with all levels of staff, clients, and the public Participates in accomplishing department goals and objectives Operates to instill confidence in our care and in our facilities for patients, fellow employees, and other stakeholders Impacts patient experience by demonstrating courteous and helpful behavior and a commitment to accuracy Contributes to the success of the organization by participating in quality improvement activities EDUCATION/EXPERIENCE High school diploma/GED required One-year medical billing or medical claims experience required; two years' experience preferred One-year electronic medical records system experience required; PACE preferred CPT, HCPCS and ICD-10 and revenue code experience preferred Experience with eligibility verification preferred Experience with revenue cycle processes in the healthcare setting required; examining/processing Medicare and Medicaid claims preferred ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities) Excellent verbal and written communication skills, including superior composition, typing and proofreading skills Ability to interpret a variety of instructions in written, oral, diagram, or schedule form Knowledgeable about third-party administrator systems Knowledgeable about and experience with using Microsoft Office Applications Knowledgeable about and experience with principles and practices of the health care industry and familiarity with Medi-Cal and Medicare payers Knowledgeable about and experience with medical office procedures and billing insurance carriers. Ability to successfully manage multiple tasks simultaneously Excellent planning and organizational ability Ability to work as part of a team as well as independently Ability to work with highly confidential information in a professional and ethical manner Physical Requirements Ability to lift/carry 25 lbs./weight Ability to stand or sit for long periods of time Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more! Pay range: $24.95 - $34.93/hr hourly, depending on experience/qualifications.

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.

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. About GEICO The Government Employees Insurance Company (GEICO) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. GEICO is a wholly owned subsidiary of Berkshire Hathaway and is the third largest auto insurer in the United States. In 2023, GEICO earned premiums worth over $40 billion U.S. dollars. GEICO is going through a massive digital transformation to re-platform the Insurance industry, removing friction across Customers, Partners, Marketplace, Segments, Channels, and Experiences as we grow our reach and market share. About The Role GEICO is hiring a Innovation Analyst to join their Claims Innovation team. As an Innovation Analyst, you will support GEICO's Claims Innovation team in identifying, analyzing, and implementing opportunities to improve processes and technology. This role partners with cross-functional teams to deliver innovative solutions that enhance efficiency, accuracy, and customer experience. Responsibilities: * Evaluate and analyze existing claims processes, data, and performance metrics to identify areas of opportunity for efficiency, effectiveness, or accuracy * Gather and analyze data to provide insights into claims processes and performance metrics * Support the development of actionable strategies and assist in implementing process and technology enhancements. * Assist the Director, Claims Innovation in establishing priorities, goals, and objectives * Collaborate with Operations, Product, AI/ML, and Engineering teams to define and prioritize requirements. * Prepare reports and presentations summarizing findings, recommendations, and project progress. * Contribute to and/or lead pilot programs, POC's, or A/B testing and reporting on performance and progress * Participate in innovation workshops, ideation sessions, and design sprints. * Monitor project risks, benefits, and performance metrics; escalate issues as needed. * Stay informed on industry trends, emerging technologies, and best practices. About You Skills & experiences: * 3+ years of experience in business process optimization, business analysis, consulting, innovation, or process engineering. * Leadership experience in P&C insurance claims * Bachelor's degree in Business, Finance, Economics, Statistics, or related field. * Knowledge of innovation methodologies, processes, and principles * Strong analytical skills and ability to interpret data for decision-making. * Effective communicator with strong collaboration skills. * Demonstrated ability to adapt and learn in a fast-paced environment. * Commitment to diversity, equity, and inclusion. Leadership qualities: * Leads from the front and isn't shy about using their voice * Ability to lead and influence with empathy and humility * Ability to navigate and lead through complexity * Curiosity, critical thinking skills; a lifelong learner who sees situations through multiple lenses * Exceptional character and an ability to instill confidence and build trust. Someone who possesses high emotional intelligence, and is an attentive, empathetic listener Location: Remote, or available office #LI-HB1 Annual Salary $82,000.00 - $172,200.00 The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations. At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. * Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. * Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. * Access to additional benefits like mental healthcare as well as fertility and adoption assistance. * Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

Job DescriptionJob ProfileJob TitleWorkers Compensation Claims Examiner (1360552) LocationRemote/Hybrid in San Diego CAHire TypeContingentHourlyopenWork ModelMonday - FridayContact Phone(443)-345-3305 Contact Emailsean@marykraft.com Nature & Scope:Positional Overview Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices, service expectations, and specific client requirements. The examiner will also identify subrogation opportunities and negotiate settlements to achieve cost-effective resolutions.Role & Responsibility:Tasks That Will Lead To Your Success Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Manage claims through well-developed action plans, ensuring timely and appropriate resolutions. Negotiate settlement of claims within designated authority limits. Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim. Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness. Prepare necessary state filings within statutory limits. Oversee the litigation process to ensure timely and cost-effective resolution of claims. Coordinate vendor referrals for additional investigation or litigation management. Implement cost-containment strategies, including partnerships with vendors, to reduce overall claim costs. Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets. Report claims to excess carriers and respond to their inquiries in a timely and professional manner. Maintain communication with claimants and clients, fostering professional relationships. Ensure claims files are properly documented, with accurate coding. Refer complex cases to supervisors or management as needed. Skills & Experience:Qualifications That Will Help You Thrive Bachelor's degree from an accredited college or university preferred. Professional certifications relevant to workers' compensation claims are preferred. Five (5) years of claims management experience or an equivalent combination of education and experience required. Minimum of 3 years of California workers' compensation claims handling experience is mandatory. Self-Insurance Plan (SIP) certification is preferred but not mandatory. Expertise in insurance principles and laws, claim and disability duration, and medical management practices. Strong knowledge of Social Security, Medicare application procedures, and recovery processes. Excellent communication skills, both oral and written, including presentation abilities. Proficiency in Microsoft Office and general PC literacy. Strong analytical, interpretive, and problem-solving skills. Strong organizational skills and the ability to manage multiple priorities effectively. Excellent negotiation skills. Ability to work collaboratively in a team environment and meet or exceed service expectations.

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 purpose of this job is to ensure efficient, effective activity within technical units assigned to produce professional and optimal claim results through aggressive claim management. This position exists to oversee, lead, and guide a unit of Claims staff while working in compliance with Company philosophies, practices, and procedures. ESSENTIAL DUTIES AND RESPONSIBILITIES Establishes and maintains a high degree of the Company's philosophy and technical practices throughout the claims operation. Conducts periodic audits of staff assignments to ensure operational workflow. Collaborates in the preparation and delivery of Workers' Compensation education and training programs. Manages control and direction of reported claims within the authority level established by management. Participates in different Department projects as assigned by upper Management. Approves, reserves and makes payments within designated limitations of authority. Approves reserves and payments within designated limitations of authority. Executes claims with a reserve authority of no greater than $175,000. Recommends claim settlements on those exceeding authority, to ensure reserve adequacy on each claim within the unit. Develops, coaches, leads and mentors a team of claims personnel to ensure claims are processed promptly, professionally and economically. Communicates Mission, Values and other organization operating principles to staff. Establishes and maintains the overall work cadence and ensures performance and outcomes strive for excellence in delivery and customer experience. Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition and retention. Establishes hiring criteria, on-boarding and training requirements for incoming staff. Oversees the performance management and development process for the department and performs performance management duties, development planning and coaching for direct reports. Ensures adherence to all Company policies and procedures and compliance responsibilities. SUPERVISORY RESPONSIBILITIES Directly supervises a unit of employees within the Claims team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum 4-6 years of related examining experience required. CERTIFICATES, LICENSES, REGISTRATIONS IEA Certificate, WCCP Accreditation preferred. KNOWLEDGE AND SKILLS Strong understanding of Workers' Compensation claims principles and application. Strong foundation of business acumen. Basic understanding of personnel and performance strategies. Excellent verbal and written communication skills, time management, and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Ability to effectively present information to top management and/or public groups Ability to apply principles of logic to a wide range of intellectual and practical problems. 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

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 purpose of this job is to ensure efficient, effective activity within technical units assigned to produce professional and optimal claim results through aggressive claim management. This position exists to oversee, lead, and guide a unit of Claims staff while working in compliance with Company philosophies, practices, and procedures. ESSENTIAL DUTIES AND RESPONSIBILITIES Establishes and maintains a high degree of the Company's philosophy and technical practices throughout the claims operation. * Conducts periodic audits of staff assignments to ensure operational workflow. * Collaborates in the preparation and delivery of Workers' Compensation education and training programs. * Manages control and direction of reported claims within the authority level established by management. * Participates in different Department projects as assigned by upper Management. Approves, reserves and makes payments within designated limitations of authority. * Approves reserves and payments within designated limitations of authority. * Executes claims with a reserve authority of no greater than $175,000. * Recommends claim settlements on those exceeding authority, to ensure reserve adequacy on each claim within the unit. Develops, coaches, leads and mentors a team of claims personnel to ensure claims are processed promptly, professionally and economically. * Communicates Mission, Values and other organization operating principles to staff. * Establishes and maintains the overall work cadence and ensures performance and outcomes strive for excellence in delivery and customer experience. Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition and retention. * Establishes hiring criteria, on-boarding and training requirements for incoming staff. * Oversees the performance management and development process for the department and performs performance management duties, development planning and coaching for direct reports. * Ensures adherence to all Company policies and procedures and compliance responsibilities. SUPERVISORY RESPONSIBILITIES Directly supervises a unit of employees within the Claims team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum 4-6 years of related examining experience required. CERTIFICATES, LICENSES, REGISTRATIONS IEA Certificate, WCCP Accreditation preferred. KNOWLEDGE AND SKILLS Strong understanding of Workers' Compensation claims principles and application. Strong foundation of business acumen. Basic understanding of personnel and performance strategies. Excellent verbal and written communication skills, time management, and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Ability to effectively present information to top management and/or public groups Ability to apply principles of logic to a wide range of intellectual and practical problems. 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

Healthcare Talent is assisting our client in hiring a Supervisor, Claims (CQI) for their Claims Department. The Claims Supervisor oversees the day-to-day operations of the Quality Analyst (QA) staff in the Continuous Quality Improvement (CQI) Unit of the Claims Department. This position is responsible for ensuring adherence to regulatory and internal guidelines in conjunction with company policies and procedures as they apply to claims processing and adjudication. Our client has a unique business philosophy; their goal is to provide employees with a place to excel - while really creating something meaningful in their work. This philosophy has helped them grow into an award-winning company. Employees are provided with room for advancement, competitive compensation, and an excellent benefit package. Job Description Position Responsibilities • Train, audit and supervise all QA staff to ensure adherence to the Medi-Cal and Medicare processing guidelines. Identify any new learning opportunities for staff (i.e. new desktops). • Monitor staff to ensure department turn-around times for claims auditing are met. Ninety five percent (95% of all claims must be paid or denied within 30 calendar days and 100% within 60 days from date of receipt to date of financial run. • Must serve as a back up to claims processing when needed to ensure the department turn-around times are met and maintain inventory within 21 days on hand. • Responsible for prompt communication with staff. Must schedule monthly unit meetings to go over any changes to programs or training issues; schedule monthly one-on-one meetings with staff to go over their monthly progress regarding their success factors (production, quality, etc). • Plan work for staff, assign daily claims and determine priorities of work done by staff. • Set or recommend work performance standards. • Review work procedures and recommend or change procedures to be more time/cost efficient. • Assist with interviewing job applicants and make recommendations for hire as needed. • Train, evaluate, and provide performance feedback to staff. • Conduct employee counseling/corrective interviews with the assistance of Human Resources. • Conduct claims presentations as assigned. • Other projects and duties as assigned. Qualifications Required Skills • Diffuse emotional situations with employees and/or provider representatives. • Interact with peers face-to-face, over the phone and in writing in a manner that is professional and productive. • Influence others using a positive approach. • Provide clear, concise instruction to individuals of varying skill levels. • Troubleshoot problem areas. • Encourage and utilize suggestions and new ideas. • Manage and keep track of multiple tasks. • Remain objective when dealing with emotional topics or when having to give feedback to staff. • Establish and maintain effective working relationships with all levels of staff, other programs, agencies, and the general public. • Effectively utilize computer and appropriate software and interact as needed with company claims processing systems. • Speak and write clearly and concisely. • Encourage the professional performance and development of subordinate staff. • Plan, organize and prioritize work. Required Experience Experience & Education • High school diploma or equivalent is required; some college preferred. • 3+ years of experience in a managed care environment that would have developed the knowledge and abilities listed. • Substantial practical knowledge and understanding of relevant business practices and applicable regulations/policies. • Previous experience in directing the work of others (i.e. training, responding to questions, etc.) and supervisory experience are preferred. • Demonstrated ability to work closely and often with others. Knowledge of: • Principles and techniques of effective supervision. • Technical area(s) of medical claims administration, including medical terminology, CPT, ICD-9 codes and HCPCS codes. • Medi-Cal and Medicare program guidelines. • Benefit interpretation and administration. • Department reports, their purpose and how to interpret them. • Department procedures, policies and expectations. • Fundamental principles of writing and grammar, including proper report and correspondence format, correct spelling and proper word usage, grammar, punctuation, and sentence structure. • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Additional Information If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document. We look forward to hearing from you today! ************************ *********************************

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 Liability Claims Manager - Dedicated Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **OFFICE LOCATIONS** Concord, CA Roseville, CA San Diego, CA **PRIMARY PURPOSE** : To manage the technical and operational functions within a dedicated client; to ensure consistent delivery of quality services; to manage staffing and training needs of specified unit; and to oversee budget preparation and profit and loss management within the dedicated client program. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Responsible for overall operational management for assigned dedicated client. + Oversees company and client internal quality review process and reports monthly. + Establishes policy and procedure to ensure compliance to best practices, claims management services standards, state regulations and client service requirements; ensures compliance with client internal controls, audit requirements and service agreement requirements; plans, develops and implements team, policies and procedures for dedicated client activity. + Establishes business plan with goal and objectives for the partnership of the dedicated client. + Works with Program Management to: (a) make recommendations for cost savings strategies for client and partners; (b) keep client, program manager and colleagues informed of statutory or regulatory requirements/developments by jurisdiction which may impact procedures; (c) resolve client issues; (d) communicate frequently with key client personnel; and (e) represent company as liaison to clients and partners. + Identifies and resolves issues with company representatives. + Monitors management reports relating to the dedicated client's performance. **SUPERVISORY RESPONSIBILITIES** + Administers company personnel policies in all areas and follows company staffing standards and training recommendations. + Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. + Provides support, guidance, leadership and motivation to promote maximum performance. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. **Experience** Eight (8) years of related experience or equivalent combination of education and experience required to include **four (4) years Liability claims management experience and two (2) years supervisory experience.** **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _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 $115,000 - $130,000. 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._ \#Claims #ClaimsManager#Hybrid #LI-Hybrid #LI-Remote #LI-AM1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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**

SUMMARY Responsible for managing, reporting and monitoring liability claims files. Provides coverage/policy interpretation for liability claims, as well as guidance on liability coverage and claims issues. Provides proactive oversight, guidance, and professional development to a team of liability Claims Adjusters. ESSENTIAL DUTIES AND RESPONSIBILITIES Partners proactively with management to inform, analyze, educate and mitigate potential future liability claims; identifies high frequency and/or severity trends for immediate action; Resolves complex exposure claims, using high service oriented file handling working closely with clients to resolve conflicts, settle disputes, resolve grievances; Presents potentially problematic and high value cases to management for review and settlement boundary approval; Manages and maintains information regarding claims and requests for documents from employees and others, and monitors claims; Maintains claims information for regular quarterly review, and carrier notifications. Files all notices and reports of claims to all carriers; Reviews/acts on reported litigated claims; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties; Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization; Proactively addresses cases involving a legal inquiry or dispute and develops a strategy to bring a case to satisfactory resolution; Supervises staff including; motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate; Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information); Other duties as assigned. QUALIFICATIONS EDUCATION / EXPERIENCEBachelor's Degree or equivalent combination of education and experience Eight (8) or more years related work experience Valid Insurance License SKILLSExcellent verbal and written communication skills Good leadership, problem solving, and time management skills Good planning, organizational, and prioritization skills Ability and motivation to work independently Ability to interface with executive - internally and externally Proficient in Microsoft Office products Frequent travel required (35%+)#LI-DM1

The Analyst, Operations Planning Claims position will support all functions within the in/outbounds damage claims Department, with an emphasis on data collection and analysis for damage claims purposes. The person in this role will develop and maintain various reports, and communicate with customers and claim related parties ( carrier, repair shop etc ) to receive all data required claims processing. Data entry ( Claims data collection, Recovery register etc ) Information gathering ( Carrier communication, Repair vendor selection & follow up ) Organize & Provide claims status updates for customers and carriers and outbound team daily Access various information systems to gather relevant data ( TMS / YMS ) Follow SOP for updating and maintaining daily, weekly, and monthly reports Research and identify cause of problem and seek resolution with Claims Supervisor. Access past reports and gather data from various information systems to generate reports related to claims Clerical tasks involving processing repair vendor invoices ( verifying cost, authorization, payment status etc)

SUMMARY Responsible for managing, reporting and monitoring liability claims files. Provides coverage/policy interpretation for liability claims, as well as guidance on liability coverage and claims issues. Provides proactive oversight, guidance, and professional development to a team of liability Claims Adjusters. ESSENTIAL DUTIES AND RESPONSIBILITIES Partners proactively with management to inform, analyze, educate and mitigate potential future liability claims; identifies high frequency and/or severity trends for immediate action; Resolves complex exposure claims, using high service oriented file handling working closely with clients to resolve conflicts, settle disputes, resolve grievances; Presents potentially problematic and high value cases to management for review and settlement boundary approval; Manages and maintains information regarding claims and requests for documents from employees and others, and monitors claims; Maintains claims information for regular quarterly review, and carrier notifications. Files all notices and reports of claims to all carriers; Reviews/acts on reported litigated claims; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties; Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization; Proactively addresses cases involving a legal inquiry or dispute and develops a strategy to bring a case to satisfactory resolution; Supervises staff including; motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate; Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information); Other duties as assigned. QUALIFICATIONS EDUCATION / EXPERIENCEBachelor's Degree or equivalent combination of education and experience Eight (8) or more years related work experience Valid Insurance License SKILLSExcellent verbal and written communication skills Good leadership, problem solving, and time management skills Good planning, organizational, and prioritization skills Ability and motivation to work independently Ability to interface with executive - internally and externally Proficient in Microsoft Office products Frequent travel required (35%+)#LI-DM1

SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage. SBMA has a current need for a full-time Senior Claims Analyst. The Senior Claims Analyst is a critical member of SBMA's Claims Department, responsible for overseeing the most complex claims adjudication tasks and ensuring operational excellence across all claims functions. This role provides advanced support, guidance, and informal mentorship to Claims Analyst I and II team members, acting as a subject matter expert (SME) for HealthPac and SBMA's internal processes. The Senior Claims Analyst helps streamline workflows, improve accuracy and turnaround times, and support continuous improvement efforts across the department. This position plays a key role in resolving escalated issues, developing SOPs, and enhancing departmental efficiency. SUPERVISORY RESPONSIBILITIES: • No direct reports but serves as a lead and informal mentor to Claims Analyst I and II staff. • May assist with onboarding and training of new Claims Analysts. • Acts as point of contact for escalated claims-related questions or issues within the team. RESPONSIBILITIES AND DUTIES (Included but not limited to): 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 essential functions. Review and process complex or high-priority claims, including escalated or disputed claims. Provide quality assurance and auditing of Claims Analyst I and II work to ensure compliance with turnaround time (TAT), accuracy, and best practices. Serve as department liaison to IT or vendor support on claims system-related issues or enhancements. Lead training sessions and support the professional development of junior analysts. Assist the Claims Manager in updating and maintaining standard operating procedures (SOPs) and training documentation. Analyze claims trends, identify root causes of processing errors, and recommend workflow improvements. Coordinate with internal teams (Eligibility, Client Services, Accounting) to resolve cross-functional issues. Manage specialized tasks such as high-dollar claims review, provider dispute resolution, or out-of-network pricing strategies. Support and generate weekly, monthly, and ad hoc claims reporting. Maintain expert-level knowledge of HealthPac and payer requirements. Perform all duties of a Claims Analyst II when needed. This description is not meant to be all-inclusive and may be modified from time to time at the discretion of management. REQUIRED EDUCATION AND EXPERIENCE: High School Diploma or equivalent Minimum 4 years of experience in medical claims adjudication Minimum 3 years of HealthPac system use Demonstrated experience working with Reference Based Pricing (RBP), QPA, and complex claims scenarios PREFERRED EDUCATION AND EXPERIENCE: 5+ years of medical claims experience, with increasing levels of responsibility Previous experience in a lead or trainer role within a claims department KNOWLEDGE, SKILLS, AND ABILITIES: Expert-level proficiency in HealthPac Strong understanding of medical billing, coding, and adjudication processes Proven ability to train, guide, and mentor peers Advanced Excel and reporting skills Exceptional attention to detail and organizational abilities Excellent verbal and written communication skills Ability to handle sensitive information with confidentiality Strong problem-solving skills and ability to think critically under pressure Able to work independently while coordinating with multiple departments PHYSICAL REQUIREMENTS: Prolonged periods of sitting at a desk and working on a computer Must be able to lift up to 15 pounds at times Pay Details: The base compensation range for this position is $33 - $35. This range reflects Acrisure's good faith estimate at the time of this posting. Placement within the range will be based on a variety of factors, including but not limited to skills, experience, qualifications, location, and internal equity. Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership. Why Join Us: At Acrisure, we're building more than a business, we're building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future. Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York. Employee Benefits We also offer our employees a comprehensive suite of benefits and perks, including: Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time. Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription. Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs. Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage. … and so much more! This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location. Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting ******************* . California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy. Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice. Welcome, your new opportunity awaits you.

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 $67,000.00 - $110,600.00 Target Openings 1 What Is the Opportunity? This position is eligible for a sign-on bonus. This position is hybrid. Employees may elect to work up to 2 days per week from their primary residence. Under general supervision, the position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims. Provide 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. This job does not manage staff. What Will You Do? * Timely coverage analysis and communications with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel. * Investigates each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Takes necessary statements. * Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Keeps effective diary management system to ensure that all claims are handled timely. At required time intervals, evaluates liability and damages exposure, and establishes proper indemnity and expense reserves. * Utilizes evaluation documentation tools in accordance with department guidelines. * Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. * Negotiates disposition of claims with insureds and claimants or their representatives. * Recognizes and implements alternate means of resolution. * May manage litigated claims. Develops litigation plan with staff or panel counsel, track and control legal expenses Assures appropriate resolution. * Maintains claim files, have an effective diary system, and document claim file activities in accordance with established procedures. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options. * Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit. * Appropriately deals with information that is considered personal and confidential. * Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers. * Represents the company as a technical resource, attends legal proceedings as needed, act within established professional guidelines as well as applicable state laws. * Provides quality customer service and ensures file quality. * Shares accountability with business partners to achieve and sustain quality results. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * 2 years bodily injury liability claim handling experience. * Commercial Claim handling experience. * General knowledge and skill in claims handling and litigation. * Basic working level knowledge and skill in various business line products. * Demonstrated ownership attitude and customer centric response to all assigned tasks - Intermediate. * Demonstrated good organizational skills with the ability to prioritize and work independently. - Intermediate. * Demonstrated strong written, verbal and interpersonal communication skills including the ability to convey and receive information effectively. * Intermediate. * Attention to detail ensuring accuracy - intermediate. * Analytical Thinking - Intermediate. * Judgment/Decision Making - Intermediate. * Communication - Intermediate. * Negotiation - Intermediate. * Insurance Contract Knowledge - Intermediate. * Principles of Investigation - Intermediate. * Value Determination - Intermediate. * Settlement Techniques - Intermediate. * Medical Knowledge - Intermediate. What is a Must Have? * One-year bodily injury liability claim handling experience, or one year of liability claim experience, or successful completion of Travelers Claim Representative training program. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Job DescriptionSalary: $28-$32 Hourly, DOE AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves. AmeriPharmas Benefits Full benefits package including medical, dental, vision, life that fits your lifestyle and goals Great pay and general compensation structures Employee assistance program to assist with mental health, legal questions, financial counseling etc. Comprehensive PTO and sick leave options 401k program Plenty of opportunities for growth and advancement Company sponsored outings and team-building events Casual Fridays Job Summary The Claims Adjudicator is responsible for overseeing the claims adjudication process through effective management of claims. This role ensures the accuracy and timely processing of claims, coordinates bill payments, and collaborates with the Copay Assistance Department as needed to resolve issues. Schedule Details Location: On-Site (Laguna Hills, CA) Hours: Monday-Friday, 9:00 AM - 5:30 PM Duties and Responsibilities Collaborate closely with pharmacists and other departments to ensure seamless claims processing. Perform thorough reconciliation of daily batch postings to ensure all transactions are accurately recorded and balanced. Manage both automated and manual batch posting processes, including the accurate input and verification of claims and payment Stay informed on current billing issues and implement necessary changes to existing billing practices. Maintain comprehensive knowledge of prescription plans and their intricacies. Analyze claims, considering factors such as the cost of goods, allowed amounts, insurance coverage, and patient copays. Troubleshoot and resolve claim rejections and overrides as necessary. Use decision trees to assess whether a case will be serviced or transferred to another department. Process claims for both primary and secondary payers. Review patient coverage for primary and secondary payers and determine eligibility for copay assistance or enrollment in FHP. Coordinate with the Financial Assistance Department to secure additional funding when copay assistance is exhausted. Work with the Patient Care Coordinator Supervisor to address delays in claim scheduling and order statuses. Update insurance information and add new payors when patients experience insurance changes. Ensure accuracy in NCPDP claim submissions. Review order profitability and manage the 3 & 5 queues to complete margin reviews and update last events. Oversee the B queue, test claim refill orders, and update last events. Manage the 541 queue, confirming delivery tickets and resolving rejected claims. Accurately document patient medication coverage in progress notes. Adhere to the 14-day adjudication and scheduled delivery window. Promptly report underpaid claims, reimbursement changes, pricing issues, or billing/cost assistance issues to the supervisor. Perform other duties as assigned. Required Qualifications Previous pharmacy experience Strong interpersonal skills with the ability to collaborate effectively Excellent verbal and written communication skills Ability to work independently and manage multiple deadlines in a fast-paced environment Strong organizational skills and keen attention to detail Proficient typing and keyboarding skills Fluency in reading, writing, speaking, and understanding English Preferred Qualifications Experience with prior authorization/override processing Familiarity with CPR+ software AmeriPharmas Mission Statement Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care! Physical Requirements 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 continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus. EEO Statement The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be anexhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and otherduties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer.All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.

Job DescriptionCLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are highly needed. Must have reliable transportation, along with own digital recorder and camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: W/C and P&C investigations Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Powered by JazzHR ae8MYMuvvL

Navarro Research and Engineering is recruiting a TRU Waste Certification Specialist II (3735) in Carlsbad, NM. Navarro Research & Engineering is an award-winning federal contractor dedicated to partnering with clients to advance clean energy and deliver effective solutions for complex challenges in the nuclear and environmental fields. Joining Navarro means being a part of an exceptional team committed to quality and safety while also looking for innovative strategies to create value for the client's success. Headquartered in Oak Ridge, Tennessee, Navarro has active programs in place across the nation for DOE/NNSA, NASA, and the Department of Defense. This position will support the Department of Energy Carlsbad Field Office (CBFO) in Carlsbad, NM. CBFO's mission includes management and support of the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico and the National Transuranic Waste Program (NTP). The TAC services will include: audits and assessments, security, program management, mining engineering, construction management, WIPP site operations, environmental and regulatory compliance, nuclear and industrial safety, scientific and international programs, TRU waste characterization and certification, TRU waste transportation and packaging, general business operations, information technology, document control, and executive management support. Responsibilities: Performing oversight of WIPP site underground operations to ensure compliance with applicable requirements for the safe handling and emplacement of mixed TRU waste in the underground repository, as well oversight of general overall mining activities. This position will also collaborate with the facility representatives to provide oversight for all waste handling activities.

Replies within 24 hours Benefits: Health insurance Opportunity for advancement Paid time off Training & development Position Overview As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. The Coordinator will be responsible to follow up daily with the OPS team to ensure and that all required documentation, estimates and procedures are followed according to required program guidelines. A successful Coordinator will possess tenacity and thrives in a fast-paced environment. The coordinator who is detail oriented and able to focus with many projects in varying degrees of completion will be most successful in this position. Job Responsibilities Understanding of the claims flow process - Water Mitigation, Reconstruction, Contents, and other Environmental work Manages data entry for each claim from First Notice of Loss through to completion of job in the CRM system Daily review of compliance tasks and all job tasks are completed on time Monitor and update jobs in required operating system making sure the job flows efficiently through the claims process requirements and cycle times Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call Creates and or assists with job estimate, reviews final estimate to ensure estimate is complete per company standards Manages Customer Service issues and complaints, documenting actions and resolution Understanding of all company cycle times and SLAs required for each job and phase Client Care Calls - ensure constant, often daily, communication with the customer, may communicate with adjuster Ensure daily notes are entered in all jobs, contacting relevant participants and escalating to the department manager as required May be responsible for creating job estimate and or assisting the Estimator/Project Manager with final estimate Job Requirements High school diploma/GED required Bachelor's Degree or applicable experience preferred, work experience will be considered IICRC Certifications preferred but not required: WTR, ASD, OCT, STC Exceptional Customer Service skills 1-3 years of Xactimate experience required- proficient use Xactimate 28 Experience with Microsoft© Office application (Word, Outlook, PowerPoint, and Excel) required Personal time management and organizational skills Strong verbal and written communication skills Dependable and adaptable to operate within a fast-paced work environment Ability to manage highly confidential information Strong problem-solving skills Proficient at using Microsoft Office, Outlook, CRM software Experience do you have with customer interaction and conflict resolution Physical Demands and Working Conditions The physical demands are representative of those that must be met by an employee to perform the essential function to this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Incumbent must be prepared to: Move up to 20 pounds occasionally, by lifting, carrying, pushing, pulling, or otherwise repositioning objects. Sitting for long periods of time while using office equipment such as computers, phones etc. Fingering and Repetitive motions; such as movement of wrists, hands and fingers while picking, pinching and typing during your normal working environment. Express or exchange ideas with others quickly, accurately, and receive and act on detailed information. Close visual acuity to perform detail-oriented activities at distances close to the eyes, such as preparing and analyzing data, viewing computer screen and expansive reading. Be exposed to various inside working conditions: The change of building environment such as with or without air conditioning and heating. May be required to travel for short periods of time. Disclaimer The above statements are intended to describe the general nature and level of work being performed by associates 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. The Company reserves the right to modify this description in the future, with or without notice to the employee. This Job Description does not create an employment contract, implied or otherwise, and employment with the Company remains at will. These responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. Compensation: $60,000.00 - $75,000.00 per year Built on a foundation of great brands and employees with a passion for service, our vision is to be the leading provider of essential services through empowered people, world-class customer service and convenient access. By joining ServiceMaster, you'll be part of a talented network of employees with a shared vision. Our environment is a diverse community where successful people work together to achieve common goals. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to The ServiceMaster Company, LLC.

Job DescriptionWorker Compensation Claims Adjuster Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Glendale, CA We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations. Our Mission: To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives. Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes. Our Goal: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients. Your Impact: Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance Ensure all claims are handled in accordance with relevant statutes and company guidelines Address personnel issues promptly and decisively, keeping management informed of corrective action Foster a collaborative and productive team environment focused on excellence in claim resolution Our Offer: Competitive salary and benefits package, including medical, dental, vision, and 401(k) Opportunity for professional growth and advancement in a dynamic organization Collaborative work environment with a team dedicated to workers' compensation excellence Interested? Get in Touch: To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following: Apply to this posting Call me directly at ************ Email ************************ We look forward to hearing from you! “Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.” Powered by JazzHR pG79VZ5NYl