Claim Processor Jobs in Westborough, MA

Boston IVF is a leader in reproductive health, dedicated to helping individuals and couples grow their families through compassionate, personalized care. With decades of experience, advanced research, and a commitment to excellence, we have been at the forefront of fertility treatment, supporting our patients' dreams of parenthood. Our team is composed of skilled professionals who work collaboratively to deliver the highest standards in patient care, innovation, and results. Position Overview: We are seeking a dedicated and detail-oriented Billing Specialist to join our team. This role is vital to ensuring accurate and timely reimbursement for our infertility services and requires a blend of technical billing expertise and exceptional customer service skills. Key Responsibilities: Review payer remittances for rejections or incorrect payments, and follow up promptly on unpaid claims. Communicate with payers to address issues, resubmit, and/or appeal claims within required timelines. Audit and review charges, fostering positive relationships with both payers and internal staff. Handle accounts receivable efficiently to maintain an acceptable balance. Conduct monthly reviews of insurance follow-up reports. Respond to phone inquiries from patients and others, resolving billing issues with professionalism and care. Perform additional duties as assigned. Authority & Reporting: This role operates under the direct supervision of the Billing/Operations Manager, with all questions and escalations directed to the manager. Qualifications: Minimum of 1 year of billing experience, ideally with a background in infertility services, claims processing, coding, and payer contracts. - preferred Strong attention to detail, organizational skills, and the ability to multitask effectively. Problem-solving abilities, excellent customer service skills, and the ability to work collaboratively within a team. Proficiency with computer systems and software. Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance

Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. As part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character. We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world? Learn more about our unique culture and history. Job Opportunity: Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Commercial Property Claims Examiner to join our dynamic Claims team. The Examiner will be responsible for coordinating the adjustment of commercial property claims, regularly collaborating with underwriters, internal and external customers, and marketing BHSI Claim Service to customers and brokers. We are seeking candidates with a high level of technical skill, as well as excellent communication and interpersonal skills. The position will be based in either our Boston, New York or Atlanta office. Duties & Responsibilities: * Overseeing the adjustment of commercial property claims (primary/excess/quota share); * Overseeing assignments to independent adjusters and other subject matter experts; * Providing outstanding customer service; * Engaging and collaborating with internal and external customers including, but not limited to, brokers, independent adjusters, Third-Party Administrators, Claims Department teammates, underwriters, actuaries, loss prevention engineers; * Analyzing coverage and drafting coverage position letters; * Working closely with coverage and / or litigation counsel; * Evaluating loss information and providing loss exposure assessments; * Setting file reserves within financial authority; * Making claim file reserve recommendations to next level management; * Documenting claim files with timely and comprehensive file notes; * Preparing Large Loss or other claim related reports for management; * Traveling to conferences, mediations, depositions, claims specific meetings, trials and other industry events; * Providing assistance and support to our Marine Claims team as circumstances require; Qualifications, Skills and Experience: * Experience and technical competence in all aspects of first party Commercial Property claims preferred (not a requirement); * College degree preferred (not a requirement); * Ability to work independently; * Excellent communication skills (spoken and written); * Ability to work respectfully and collaboratively in a team environment; * Ability to execute all aspects of job with a specific emphasis on customer service; * Marine claims handling experience (Inland and Ocean) seen as a "plus" (not a requirement); * Active adjuster licenses in multiple / key states seen as a plus (not a requirement); BHSI Offers: * A competitive package and exciting growth opportunities for career-oriented teammates * A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders * A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework NOTE: Compensation will be commensurate with experience. This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization. The base salary range for this position in New York is from $75,000 - $95,000 along with annual bonus eligibility; a candidate's actual salary is determined by their relevant skills and experience. We value our teammates - both their capabilities and character - as demonstrated by our amazing culture.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Examiner, 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_ **_$65,000- $77,000_** _. 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._ **_Always accepting applications._** 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.** **Taking care of people is at the heart of everything we do. Caring counts** Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)

This role is a Hybrid Role: After 90 days (in good performance standing), three days in the office and two days remote. Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: Provides voice to voice contact within 24 hours of first report. Conducts timely coverage analysis and communication 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, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates 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. Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. Utilizes evaluation documentation tools in accordance with department guidelines. Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Maintains and document claim file activities in accordance with established procedures. Attends depositions and mediations and all other legal proceedings, as needed. Protects organization's value by keeping information confidential. Maintains compliance with Claim Department's Best Practices. Provides quality customer service and ensures file quality Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. Participates in special projects as assigned. Some overnight travel maybe required. Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. Adjuster Licensure required. One to three years of experience processing claims; property and casualty segment preferred. Experience with Xactware products preferred. Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. Proficiency with Microsoft Office products required; internet research tools preferred. Demonstrated customer service focus / superior customer service skills. Excellent communication skills and ability to interact on a professional level with internal and external personnel Results driven with strong problem solving and analytical skills. Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. Detail-oriented and exceptionally organized Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave The Program Integrity Claims Examiner/Job Service Representative II is responsible for supporting processes within the Department of Family Medical Leave (DFML). The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed claims to ensure uniformity with PFML statute and regulations by analyzing fact-finding, data and information, ensure that the required information has been obtained accurately and completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process to ensure that appropriate internal procedures were followed. Provide technical assistance and guidance to Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures. Make determinations on eligibility for benefits escalated to DFML operations in accordance with PFML Statute and Regulations Who we are: DFML's mission is to implement and run the Commonwealth's Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity. What you'd do: Lead Claims Examiner/Job Service Representative II, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA, and is responsible for the following: * Provides technical assistance, guidance and counsel to agency staff, managers, and others on fact-finding, the resolution of PFML case issues and procedural questions concerning eligibility for PFML benefits in order to insure consistent Interpretation of the law. * Reviews escalated PFML applications Involving employer conflicts on claims and analyzes all fact-finding, data and Information to ensure that the required Information has been obtained accurately and completely and properly adjudicates the application based on department operational procedures, statutory and regulatory requirements. * Conducts regular case reviews and discussions with Job Service Representative I's to develop and enhance their capacity and ability to conduct complete and accurate fact finding and make appropriate determinations. * Conducts both Informal and formal quality reviews of the work of Job Service Representative I's) to evaluate quality and identify improvement opportunities. * Provides training to Job Service Representative I's to enhance their knowledge of the Paid Family and Medical Leave, Regulations, Policies, and Procedures and their ability to apply this knowledge effectively to application determinations. * Participates in work groups to develop and enhance procedures for implementing new laws and regulations. * Interprets and explains relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures * Gather data & write reports on performance quality & corrective action recommendations. * Helps to update standard operating procedures in coordination with current Operational protocols when system enhancements or new regulations are added. * Provides information on Department of Paid Family and Medical Leave to employers, claimants and the general public through webinars, stakeholder meetings, correspondence and by the telephone. * Performs related duties such as preparing written reports, maintaining records and data interpretation. * Performs related miscellaneous duties as required and assigned. Why should you join DFML? * The idea of working for a "government startup" excites you. * You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life. * You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives, and will value you as both a coworker and as a person. Who you are We're seeking candidates who have: * Ability to relate in a positive manner with claimants, employers, agency staff members and others in eliciting ail necessary information to issue claim determinations. * Ability to exercise strong technical knowledge of agency, federal and state laws, rules, regulations, codes, policies and procedures governing DFML in order to examine and resolve most complex DFML applications. * Experience in adjudicating claims. * Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence. * Ability to understand, explain and apply the laws, rules and regulations, policies and procedures governing agency activities. * Ability to exercise discretion in handling confidential information. * Ability to work under narrow time constraints. * Ability to negotiate solutions to complex problems. * Ability to interpret variety of instructions in written, oral, picture or schedule form. * Ability to define problems, collect data, establish facts and draw valid conclusions. * Knowledge of work simplification methods. * Ability to supervise, including planning and assigning work according to the nature of the job to be accomplished, the capabilities of subordinates' and available resources; controlling work through periodic reviews and/or evaluations; determining subordinates training needs and providing or arranging for such training; motivating subordinates to work effectively; determining the need for disciplinary action and either recommending or initiating disciplinary action. * Ability to adjust to varying or changing situations to meet emergency or changing program requirements. First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have (A) at least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or (B) any equivalent combination of the required experience and the substitutions below. Substitution: I. An Associate's degree may be substituted for one (1) year of the required experience. II. A Bachelor's degree or higher may be substituted two (2) years of the required experience. III. A Master's or higher degree may be substituted for the required experience. Comprehensive Benefits When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. Description Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available for a Claims Specialist within our Commercial Lines Shared Economy team! The Claims Specialist II, Rideshare works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; Westborough, MA; or Weatogue, CT. Please note this policy is subject to change. We are open to fill this position as a Claims Specialist II, Senior Claims Specialist I or Senior Claims Specialist II, depending on candidate experience. Salary listed is for the entire country and may vary based on candidate location. Responsibilities: * Manages an inventory of claims to evaluate compensability/liability. * Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. * Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. * Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. * Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. * Performs other duties as assigned. We will focus on candidates who have the following experience: * Attorney represented claimants for Bodily Injury claims in Shared Economy, Rideshare, Delivery Network Company or large Commercial Casualty losses. * At least one year of recent litigation management experience. Qualifications * BS/BA degree or equivalent work experience. * Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. * Required to obtain and maintain all applicable licenses. * Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). * Knowledge of claims investigation techniques, medical terminology and legal aspects of claims. About Us This position may have in-office requirements depending on candidate location. At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That's why we provide an environment focused on openness, inclusion, trust and respect. Here, you'll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession. Liberty Mutual has proudly been recognized as a "Great Place to Work" by Great Place to Work US for the past several years. We were also selected as one of the "100 Best Places to Work in IT" on IDG's Insider Pro and Computerworld's 2020 list. For many years running, we have been named by Forbes as one of America's Best Employers for Women and one of America's Best Employers for New Graduates as well as one of America's Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: ******************************************************* We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * San Francisco * Los Angeles * Philadelphia

This role is a Hybrid Role: After 90 days (in good performance standing), three days in the office and two days remote. Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: Provides voice to voice contact within 24 hours of first report. Conducts timely coverage analysis and communication 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, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates 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. Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. Utilizes evaluation documentation tools in accordance with department guidelines. Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Maintains and document claim file activities in accordance with established procedures. Attends depositions and mediations and all other legal proceedings, as needed. Protects organization's value by keeping information confidential. Maintains compliance with Claim Department's Best Practices. Provides quality customer service and ensures file quality Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. Participates in special projects as assigned. Some overnight travel maybe required. Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. Adjuster Licensure required. One to three years of experience processing claims; property and casualty segment preferred. Experience with Xactware products preferred. Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. Proficiency with Microsoft Office products required; internet research tools preferred. Demonstrated customer service focus / superior customer service skills. Excellent communication skills and ability to interact on a professional level with internal and external personnel Results driven with strong problem solving and analytical skills. Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. Detail-oriented and exceptionally organized Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

**Hybrid** Claims Full time Westborough, Massachusetts, United States **Description** This Branch Claims Representative handles bodily injury and general liability claims through their life-cycle including - but not limited to - investigation, evaluation and claim resolution. The purpose of this position is to provide service to agents, insureds and others to ensure claims resolve accurately and timely. Work is performed under general supervision. **Responsibilities** * Investigate assigned claims, confirm coverage, and verify damages * Take loss reports directly from insured and/or claimants and/or their representatives * Initiate initial claims handling * Recommend and maintain appropriate claim file reserves * Evaluate, negotiate and settle claims * Other related duties as assigned by supervisor **Requirements** * Associate's or bachelor's degree preferred * 3 to 5 years of experience adjusting third-party liability claims; more experience preferred * Experience handling litigated and/or multi-party claims that may involve risk transfer preferred * Ability to analyze coverage and prepare coverage position letters * Ability to meet continuing education requirements for licensing purposes * Commercial lines experience a plus * Excellent understanding and skill level of claim handling and customer service * Understanding of policy contracts, insurance laws, regulation, the legal environment, and procedures * Possess excellent oral and written communication skills via in person, on the phone, or electronically * Excellent interpersonal, negotiation, and organizational skills **Benefits** Concord Group employees are eligible for a comprehensive total compensation package including but not limited to medical, vison, dental, life, and disability insurance. We offer a generous Paid Time Off Program that includes vacation, personal, sick time and holiday pay. Invest in your future with our competitive 401(k) plan with company match! As a leading regional provider of property and casualty insurance, The Concord Group helps protect the families and small businesses that enable our communities to thrive. Our positive work environment, competitive benefits, and rapid growth make The Concord Group a great place to build your career. *The Concord Group is an Equal Opportunity Employer. The Concord Group participates in E-Verify.*

Company: MAPFRE Bring your passion and enthusiasm for Claims to our TEAM! At MAPFRE we believe we are only as strong as our people. We strive to create an inclusive and welcoming culture, valuing your hard work, integrity and commitment. Come learn and grow with MAPFRE while offering top notch service to our insureds! Participate in your own Individual Development Plan (IDP) which serves as your blueprint for outlining your aspirations, goals and activities. We offer a supporting team environment. Our Casualty professionals use their specialized expertise to handle even the most complex matters seamlessly. Be part of this collaborative group of innovative claim handlers. Understandably, comprehensive benefits are important and we offer a generous package that includes: Tuition Reimbursement, Medical, Dental, Vision, Referral Bonuses and 401K match. Social Responsibility is important to MAPFRE and we offer a Volunteer program where employees are provided PTO for giving their time to a charity of their choice. Job Summary **Position can be Hybrid (2 days in Office/3 days Remote) in our Webster or Boston, MA Office or Remote** In this position, individuals will be handling a pending of Automobile Casualty losses to primarily include moderate and high severity Bodily Injury and Un/Under Insured Motorist claims. This position requires proficiency in interpreting Personal and Commercial Auto policies and may require multi-jurisdictional claims handling. Refers to and interprets policies and practices for guidance and accurate application. The individual will be responsible for all components of the adjustment process to include screening new losses to determine coverage exposures, thoroughly investigating liability, evaluate claim values, negotiate final disposition of claims with appropriate parties, and issue timely and accurate payments if appropriate. The individual will also be exposed to and responsible for litigation and/or arbitration management of claims. Frequent oral and written communication with medical providers, customers and attorneys are required and these contacts must be timely and professional. Strong telephone customer service skills and the ability to empathize with claimants and customers are needed. Individuals should possess a high level of initiative and demonstrate the ability to work both independently and in a team environment with high daily workloads in a fast paced environment. Strong business and decision making skills as well as the ability to maintain a high degree of confidentiality are required. May represent organization on specific projects. Communication involves creating and delivering varied types of messages and information and may involve persuasion and negotiation. A moderate to high degree of independence is expected. May participate in the training of other claims personnel. Knowledge, Skills and Abilities **Education:** Bachelor's Degree or professional level of knowledge in a specialized field, or equivalent, related experience. **Experience:** 2 - 4 years - or Associates Degree equivalent plus 4 - 6 years. **Knowledge:** Complete understanding and knowledge of industry practices, standards, and concepts within field of work. Applies them to perform or lead work requiring extensive analytical business skills. **Decision Making:** Makes decisions related to a wide variety of situations within management limits. Interprets guidelines and procedures, applying judgment and discretion. Decisions influence portions of a project, client relationships and/or expenditures. **Supervision Received:** Works independently under general supervision. Work is reviewed for overall adequacy in meeting objectives. **Leadership:** May provide training and guidance to less experienced staff. **Problem Solving /Operations/Direct Work Involvement:** Develops solutions to a variety of problems, typically of moderate scope and complexity. Refers to and interprets policies and practices for guidance. **Client Contacts:** Contacts other departments and or external organizations or parties frequently. Contacts are primarily at or below upper management levels. Represents organization on specific projects. Communication may involve persuasion, and negotiation. Additional Knowledge, Skills and Abilities - Three (3) years of claim adjusting experience is required. - Ability to assimilate job responsibilities quickly and professionally. - Insurance Industry Education strongly preferred. - This position requires excellent written and oral communication skills and the demonstrated ability to organize and prioritize work to assure productivity goals of managing a pending are met. - Strong telephone customer service skills and the ability to empathize is needed. - Must possess basic CRT / PC skills with accurate keyboarding abilities. - Must possess good math skills and be able to work in a fast paced environment. - Completion of the Casualty Claims training program is required. If you require an accommodation for a disability so that you may participate in the selection process, you are encouraged to contact the MAPFRE Insurance Talent Acquisition team at ******************************* . _We are proud to be an equal opportunity employer._ **Nearest Major Market:** Worcester **Job Segment:** Law, Liability, Call Center, Claims, Recruiting, Legal, Insurance, Customer Service, Human Resources Apply now »

- Claims Review Specialist, Medicare Advantage (3314760) **Job Description** Claims Review Specialist, Medicare Advantage ( **Job Number:** 3314760 ) **Description** **This is a remote role that can be done in most U.S. states.** The Medicare Advantage Claims Review Specialist processes Medicare Advantage claims that do not auto adjudicate through the claim system adhering to Mass General Brigham Health Plan's current administrative policies, procedures, and clinical guidelines. **Principal Duties and Responsibilities:** • Adjudicate claims to pay, deny, or pend as appropriate in a timely and accurate manner according to company policy and desktop procedure. • Review and research assigned claims by navigating multiple systems and platforms, then accurately capturing the data/information necessary for processing (e.g., verify pricing/fee schedules, contracts, Letter of Agreement, prior authorization, applicable member benefits). • Manually enters claims into claims processing system as needed. • Ensure that the proper benefits are applied to each claim by using the appropriate processes and desktop procedures (e.g., claims processing policies, procedures, benefits plan documents). • Communicate and collaborate with external department to resolve claims errors/issues, using clear and concise language to ensure understanding. • Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g., online training classes, coaches/mentors). • Meet the performance goals established for the position in areas of productivity, accuracy, and attendance that drives member and provider satisfaction. • Create/update work within the call tracking record keeping system. • Adhere to all reporting requirements. • Keep up to date with Desktop Procedures and effectively apply this knowledge in the processing of claims and in providing customer service. • Identify and escalate system issues, configuration issues, pricing issues etc. in a timely manner. • Process member reimbursement requests as needed. **Qualifications** **Basic Requirements:** * High School Diploma or equivalent experience * Pharmacy Technician certification is preferred but not required * At Least 2-3 years of previous experience in the health insurance industry in functions such as hospital or physician biller, call center experience, previous claims processing, or similar industry experience * Attention to detail, decision making problem solving, time management and organizational skills, communication and teamwork. * Basic math and language skills * Demonstrated competency in data entry **Preferred Qualifications:** * Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes. * Knowledge of medical terminology * Knowledge of claim forms (professional and facility) * Knowledge of paper vs. electronic filing and medical billing guidelines preferred * Completion of coding classes from certified medical billing school * Professional Coder Certificate is highly desirable * Preferred Experience: * Knowledge of Medicare or Medicare Advantage Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. Description The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. This is a hybrid position, however, those within 50 miles of our offices in Boston, MA, Bala Cynwyd, PA, Plano, TX, Suwanee, GA, Indianapolis, IN, Tampa, FL and Hoffman Estates, IL; must report to the office twice a month. Please note that this policy is subject to change. Responsibilities: Manages an inventory of claims to evaluate compensability/liability. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Independently investigates, evaluates and negotiates 3 rd party liability settlements with Attorney involvement Performs other duties as assigned. Qualifications BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). Knowledge of claims investigation techniques, medical terminology and legal aspects of claims. About Us **This position may have in-office requirements depending on candidate location.** At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That's why we provide an environment focused on openness, inclusion, trust and respect. Here, you'll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession. Liberty Mutual has proudly been recognized as a "Great Place to Work" by Great Place to Work US for the past several years. We were also selected as one of the "100 Best Places to Work in IT" on IDG's Insider Pro and Computerworld's 2020 list. For many years running, we have been named by Forbes as one of America's Best Employers for Women and one of America's Best Employers for New Graduates as well as one of America's Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: ******************************************************* We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California San Francisco Los Angeles Philadelphia

The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims, in a timely and accurate manner. Schedule: Provides superior customer service consistent with company standards and goals, including inbound calls from providers and health plans. Responsible for quality and continuous improvement within the job scope. Also responsible for all actions/responsibilities described in company-controlled documentation for this position. Contributes to and supports the corporation's quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely follow-up on inquiries received and correctly logs all incoming calls and emails. Maintains the minimum accuracy standard and follows up timely to meet compliance standards for claims, pends, and tasks. Reviews claim images and batches to ensure accuracy. Uses proper plan documentation to determine benefits and correctly adjudicate. Meets and maintains the minimum production in addition to completing reports and projects given by the supervisor. Effectively participates in meetings, training, and committees as designated by the supervisor. Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets. Identifies and implements required steps for improvement. Minimum Qualifications One year of claims processing, claims logging, or customer service experience in a managed care environment. - and - Demonstrated minimum of 100 SPM on ten key and 30 WPM typing. Preferred Qualifications Associates degree or some college level coursework. Degree obtained from accredited institution. Education is verified. - and - Demonstrated excellent verbal, written, and interpersonal skills. - and - Demonstrated consistent accuracy and processing efficiency in work. - and - Demonstrated ability to resolve complex claims problems and be detailed oriented. **Physical Requirements:** Manual dexterity, hearing, seeing, speaking. **Location:** Central Office - Las Vegas **Work City:** Las Vegas **Work State:** Nevada **Scheduled Weekly Hours:** 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $18.38 - $26.65 We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (***************************************************************************************** , and for our Colorado, Montana, and Kansas based caregivers (********************************* ; and our commitment to diversity, equity, and inclusion (********************************************************************************* . Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. All positions subject to close without notice.

Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. As part of Berkshire Hathaway's insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.

*Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave* The Program Integrity Claims Examiner/Job Service Representative II is responsible for supporting processes within the Department of Family Medical Leave (DFML). The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed claims to ensure uniformity with PFML statute and regulations by analyzing fact-finding, data and information, ensure that the required information has been obtained accurately and completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process to ensure that appropriate internal procedures were followed. Provide technical assistance and guidance to Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures. Make determinations on eligibility for benefits escalated to DFML operations in accordance with PFML Statute and Regulations *Who we are:* DFML's mission is to implement and run the Commonwealth's Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity. *What you'd do:* Lead Claims Examiner/Job Service Representative II, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA, and is responsible for the following:** * Provides technical assistance, guidance and counsel to agency staff, managers, and others on fact-finding, the resolution of PFML case issues and procedural questions concerning eligibility for PFML benefits in order to insure consistent Interpretation of the law. * Reviews escalated PFML applications Involving employer conflicts on claims and analyzes all fact-finding, data and Information to ensure that the required Information has been obtained accurately and completely and properly adjudicates the application based on department operational procedures, statutory and regulatory requirements. * Conducts regular case reviews and discussions with Job Service Representative I's to develop and enhance their capacity and ability to conduct complete and accurate fact finding and make appropriate determinations. * Conducts both Informal and formal quality reviews of the work of Job Service Representative I's) to evaluate quality and identify improvement opportunities. * Provides training to Job Service Representative I's to enhance their knowledge of the Paid Family and Medical Leave, Regulations, Policies, and Procedures and their ability to apply this knowledge effectively to application determinations. * Participates in work groups to develop and enhance procedures for implementing new laws and regulations. * Interprets and explains relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures * Gather data & write reports on performance quality & corrective action recommendations. * Helps to update standard operating procedures in coordination with current Operational protocols when system enhancements or new regulations are added. * Provides information on Department of Paid Family and Medical Leave to employers, claimants and the general public through webinars, stakeholder meetings, correspondence and by the telephone. * Performs related duties such as preparing written reports, maintaining records and data interpretation. * Performs related miscellaneous duties as required and assigned. ***Why should you join DFML? * * The idea of working for a "government startup" excites you. * You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life. * You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives, and will value you as both a coworker and as a person. *Who you are* We're seeking candidates who have: * Ability to relate in a positive manner with claimants, employers, agency staff members and others in eliciting ail necessary information to issue claim determinations. * Ability to exercise strong technical knowledge of agency, federal and state laws, rules, regulations, codes, policies and procedures governing DFML in order to examine and resolve most complex DFML applications. * Experience in adjudicating claims. * Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence. * Ability to understand, explain and apply the laws, rules and regulations, policies and procedures governing agency activities. * Ability to exercise discretion in handling confidential information. * Ability to work under narrow time constraints. * Ability to negotiate solutions to complex problems. * Ability to interpret variety of instructions in written, oral, picture or schedule form. * Ability to define problems, collect data, establish facts and draw valid conclusions. * Knowledge of work simplification methods. * Ability to supervise, including planning and assigning work according to the nature of the job to be accomplished, the capabilities of subordinates' and available resources; controlling work through periodic reviews and/or evaluations; determining subordinates training needs and providing or arranging for such training; motivating subordinates to work effectively; determining the need for disciplinary action and either recommending or initiating disciplinary action. * Ability to adjust to varying or changing situations to meet emergency or changing program requirements. First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have (A) at least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or (B) any equivalent combination of the required experience and the substitutions below. Substitution: I. An Associate's degree may be substituted for one (1) year of the required experience. II. A Bachelor's degree or higher may be substituted two (2) years of the required experience. III. A Master's or higher degree may be substituted for the required experience. _*Comprehensive Benefits*_ When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! *An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. * The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. **Job:** **Community and Social Services* **Organization:** **Department of Workforce Development* **Title:** *Lead Claims Examiner (DFML)* **Location:** *Massachusetts-Boston-100 Cambridge Street* **Requisition ID:** *24000AIW*

Claims Examiner This role is a Hybrid Role: After 90 days (in good performance standing), three days in the office and two days remote. Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: Provides voice to voice contact within 24 hours of first report. Conducts timely coverage analysis and communication 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, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates 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. Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. Utilizes evaluation documentation tools in accordance with department guidelines. Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Maintains and document claim file activities in accordance with established procedures. Attends depositions and mediations and all other legal proceedings, as needed. Protects organization's value by keeping information confidential. Maintains compliance with Claim Department's Best Practices. Provides quality customer service and ensures file quality Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. Participates in special projects as assigned. Some overnight travel maybe required. Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. Adjuster Licensure required. One to three years of experience processing claims; property and casualty segment preferred. Experience with Xactware products preferred. Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. Proficiency with Microsoft Office products required; internet research tools preferred. Demonstrated customer service focus / superior customer service skills. Excellent communication skills and ability to interact on a professional level with internal and external personnel Results driven with strong problem solving and analytical skills. Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. Detail-oriented and exceptionally organized Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

This Branch Claims Representative handles bodily injury and general liability claims through their life-cycle including - but not limited to - investigation, evaluation and claim resolution. The purpose of this position is to provide service to agents, insureds and others to ensure claims resolve accurately and timely. Work is performed under general supervision. Responsibilities + Investigate assigned claims, confirm coverage, and verify damages + Take loss reports directly from insured and/or claimants and/or their representatives + Initiate initial claims handling + Recommend and maintain appropriate claim file reserves + Evaluate, negotiate and settle claims + Other related duties as assigned by supervisor Requirements + Associate's or bachelor's degree preferred + 3 to 5 years of experience adjusting third-party liability claims; more experience preferred + Experience handling litigated and/or multi-party claims that may involve risk transfer preferred + Ability to analyze coverage and prepare coverage position letters + Ability to meet continuing education requirements for licensing purposes + Commercial lines experience a plus + Excellent understanding and skill level of claim handling and customer service + Understanding of policy contracts, insurance laws, regulation, the legal environment, and procedures + Possess excellent oral and written communication skills via in person, on the phone, or electronically + Excellent interpersonal, negotiation, and organizational skills Benefits Concord Group employees are eligible for a comprehensive total compensation package including but not limited to medical, vison, dental, life, and disability insurance. We offer a generous Paid Time Off Program that includes vacation, personal, sick time and holiday pay. Invest in your future with our competitive 401(k) plan with company match! About Us As a leading regional provider of property and casualty insurance, The Concord Group helps protect the families and small businesses that enable our communities to thrive. Our positive work environment, competitive benefits, and rapid growth make The Concord Group a great place to build your career. The Concord Group is an Equal Opportunity Employer. The Concord Group participates in E-Verify.

Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. Description Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As an Associate Claims Specialist, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Plano, TX; Suwanee, GA; or Westborough, MA. Please note this policy is subject to change. This position may be filled as a Senior Claims Representative or Associate Claims Specialist. We are open to fill this position depending on related professional skills and experience. The salary listed includes all US regions and may vary based on candidate location. Responsibilities: * Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments. * Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers. * Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues. * Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims. * Determines and negotiates settlement amount for damages claimed within assigned authority limits. * Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate. * Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations. * Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed. Qualifications * Effective interpersonal, analytical and negotiation abilities required * Ability to provide information in a clear, concise manner with an appropriate level of detail * Demonstrated ability to build and maintain effective relationships * Demonstrated success in a professional environment; success in a customer service/retail environment preferred * Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent * Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory * Licensing may be required in some states About Us This position may have in-office requirements depending on candidate location. At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That's why we provide an environment focused on openness, inclusion, trust and respect. Here, you'll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession. Liberty Mutual has proudly been recognized as a "Great Place to Work" by Great Place to Work US for the past several years. We were also selected as one of the "100 Best Places to Work in IT" on IDG's Insider Pro and Computerworld's 2020 list. For many years running, we have been named by Forbes as one of America's Best Employers for Women and one of America's Best Employers for New Graduates as well as one of America's Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: ******************************************************* We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * San Francisco * Los Angeles * Philadelphia

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Examiner, 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_ **_$65,000- $77,000_** _. 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._ **_Always accepting applications._** 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.** **Taking care of people is at the heart of everything we do. Caring counts** Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)

- Claims Review Specialist (3305296) **Job Description** Claims Review Specialist ( **Job Number:** 3305296 ) **Description** **This is a hybrid role requiring an onsite presence in the Somerville office 1x/month.** The Claims Review Specialist processes claims that do not auto adjudicate through the claim system adhering to Mass General Brigham Health Plan current administrative policies, procedures, and clinical guidelines. **Primary Responsibilities:** * A djudicate claims to pay, deny, or pend as appropriate in a timely and accurate manner according to company policy and desktop procedure. * Review and research assigned claims by navigating multiple systems and platforms, then accurately capturing the data/information necessary for processing (e.g., verify pricing/fee schedules, contracts, Letter of Agreement, prior authorization, applicable member benefits). * Manually enters claims into claims processing system as needed. * Ensure that the proper benefits are applied to each claim by using the appropriate processes and desktop procedures (e.g., claims processing policies, procedures, benefits plan documents). * Communicate and collaborate with external department to resolve claims errors/issues, using clear and concise language to ensure understanding. * Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g., on-line training classes, coaches/mentors). * Meet the performance goals established for the position in areas of productivity, accuracy, and attendance that drives member and provider satisfaction. * Create/update work within the call tracking record keeping system. * Adhere to all reporting requirements. * Keep up to date with Desktop Procedures and effectively apply this knowledge in the processing of claims and in providing customer service. * Identify and escalate system issues, configuration issues, pricing issues etc. in a timely manner. * Process member reimbursement requests as needed. **Qualifications** **Basic Requirements:** * High School Diploma or equivalent experience * Pharmacy Technician certification is required * 2-3 years of previous experience in the health insurance industry in functions such as hospital or physician biller, call center experience, previous claims processing, or similar industry experience * Attention to detail, decision making problem solving, time management and organizational skills, communication and teamwork. * Basic math and language skills * Demonstrated competency in data entry **Preferred Qualifications:** * Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes. * Knowledge of medical terminology * Knowledge of claim forms (professional and facility) * Knowledge of paper vs. electronic filing and medical billing guidelines preferred * Completion of coding classes from certified medical billing school * Professional Coder Certificate is highly desirable Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.