Claim specialist jobs in Alameda, CA - 83 jobs

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

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

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

Insurance Analytics Specialist (Actuary)- Technology Ris... San Francisco, California, United States of America Insurance Analytics Specialist (Actuary)- Technology Ris... San Francisco, California, United States of America At Lockton, we're passionate about helping our people achieve their ultimate potential. Our people are curious, action-oriented and always striving to make ourselves and those around us better. We're active listeners working to ensure understanding and problem solvers developing innovative solutions. If you can see yourself delivering excellent service to clients, giving back to our communities and being a part of our caring culture, you belong here. About the Position Lockton is a global professional services firm with 6,500 Associates who advise clients on protecting their people, property and reputations. Lockton has grown to become the world's largest privately held, independent insurance broker by helping clients achieve their business objectives. To see the latest insights from Lockton's experts, check Lockton Market Update . A few of the reasons Associates love working at Lockton include: Opportunities for growth and advancement, including paid training and professional development 12-week paid parental leave A huge emphasis on community involvement Frequent athletic and wellness events Incredibly generous rewards; US Associates receive a Rolex for their 10 year anniversary! We seek an experienced Insurance Analytics Specialist/Actuary to join our team. In this role, you will be part of an engaging and dynamic brokering team building insurance products that uses creative analytics solutions to advocate for our clients. You will also serve as the daily liaison between our account team and our internal analytics partners, ensuring data completeness and quality, as well as managing workflow and work quality. The ideal candidate will have a strong foundation in insurance analytics, a solid understanding of fundamental insurance concepts, and the ability to transform complex data into actionable insights. Key Responsibilities Advanced Analytics for Bespoke Analysis • Perform sophisticated analytical research on specialized insurance topics, including innovative initiatives in autonomy and actuarial research • Design and implement analytical models to evaluate risk factors, pricing implications, and coverage considerations for specialized insurance scenarios • Translate complex insurance data into meaningful insights that drive strategic decision-making • Develop data visualization tools to communicate analytical findings to stakeholders at various levels effectively • Research industry trends and emerging risks to provide proactive recommendations on underwriting approaches • Support internal analytics initiatives by applying statistical techniques to uncover patterns and relationships within insurance data Data Review and Workload Management with our internal Analytics partners • Serve as the primary liaison between our team and internal analytics partners, anticipating their data requirements and questions • Conduct comprehensive data validation checks to ensure completeness and accuracy • Identify and resolve data discrepancies or missing elements independently • Develop and implement standardized data preparation procedures to ensure efficient workload management, streamline the review process, and minimize delays Qualifications Required Qualifications • Bachelor's degree in Analytics, Statistics, Actuarial Science, Finance, Economics, Insurance, or related field • At least 4-6 years of experience in insurance analytics, data analysis, or a related role within the insurance industry • Demonstrated understanding of fundamental insurance concepts, including supply/demand dynamics, loss components, and their interrelationships • Proficiency in data analysis tools such as Excel, SQL, and Python • Experience with data quality assurance processes and validation methodologies • Strong analytical skills with the ability to interpret complex datasets and identify meaningful patterns Preferred Qualifications • Insurance industry certifications such as ACAS, CPCU, or ARM • Experience working with claims data, policy information, and underwriting systems • Background in predictive modeling or machine learning applications in insurance • Knowledge of the forefront of technology innovations and related insurance implications • Experience with data visualization tools like Tableau or Power BI Skills and Competencies • Exceptional attention to detail and commitment to data accuracy and integrity • Strong critical thinking and problem-solving abilities to address complex analytical challenges • Collaborate effectively across internal teams and external partners by understanding diverse stakeholder priorities and delivering solutions that align technical requirements with organizational objectives • Excellent communication skills to adapt communication approaches and translate technical findings into business insights • Self-motivation and the ability to work independently while managing multiple priorities • Collaborative mindset with the ability to work effectively with cross-functional teams • Advanced knowledge of insurance industry terminology, products, and regulatory considerations Working Conditions This full-time position primarily operates in an office environment. The role may require occasional travel to meet with partners or attend industry events. Some flexibility in work scheduling may be necessary to meet project deadlines. Equal Opportunity Statement Lockton Companies is proud to provide everyone anequal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity. At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learnsfrom, celebrates and thrives because of ourbreadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long-term success. About Lockton Lockton is the largest privately held independent insurance brokerage in the world. Since 1966, our independence has allowed us to serve our clients, take care of our people and give back to our communities. As such, our 12,500+ Associates doing business in over 140 countries are empowered to do what's right every day. At Lockton, we believe in the power of all people. You belong at Lockton. How We Will Support You At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it. We are ready to meet you where you are today, and as your needs change over time. In addition to industry-leading health insurance, we offer additional options to support your overall health and wellbeing. Any Employment Agency, person or entity that submits an unsolicited resume to this site does so with the understanding that the applicant's resume will become the property of Lockton Companies, Inc. Lockton Companies will have the right to hire that applicant at its discretion and without any fee owed to the submitting Employment Agency, person or entity. Employment Agencies, who have fee Agreements with Lockton Companies must submit applicants to the designated Lockton Companies Employment Coordinator to be eligible for placement fees. Manage Consent Preferences Always Active #J-18808-Ljbffr

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

About Everest: Everest is a global leader in risk management, rooted in a rich, 50+ year heritage of enabling businesses to survive and thrive, and economies to function and flourish. We are underwriters of risk, growth, progress and opportunity. We are a global team focused on disciplined capital allocation and long-term value creation for all stakeholders, who care deeply about our impact on communities and the wider world. Job Summary: Everest Insurance, a member of Everest Re Group, Ltd., has an opportunity for an experienced claims professional or attorney to join our Auto and GL TPA Oversight - Casualty Claims team in Warren, NJ/Walnut Creek, CA/New York, NY/Hartford, CT or Philadelphia, PA. This individual will handle TPA Oversight and quality assessment for general liability and commercial auto claims. This is a hybrid position working 3 days in office, 2 remote. Responsibilities include but not limited to: * Ensure compliance with Everest TPA Claim Handling Protocols * Direct and report on focused claim reviews and file audits * Maintain active diary system * Actively manage and resolve claims when appropriate * Participate in settlement conferences and mediation as needed * Participate in meetings with policyholders and brokers as needed * Analyze claims metrics including reserve accuracy, productivity, prompt communication; and expense management * Develop and execute on action plans to address deficiencies identified within quality reviews * Conduct regular meetings with TPA adjusters and managers to discuss trends and claim handling strategy * Develop and maintain relationships with underwriting groups and brokers/agents. * Work with business partners to address customer service issues Qualifications, Education & Experience: * 6-8 years of claims handling experience or related legal experience * Past supervision experience * B.A. or B.S. required * Strong analytical and organizational skills * Excellent verbal and written communication skills * Strong negotiation and investigation skills * Strong computer use skills across multiple claim system platforms * Ability to think strategically * Ability to influence others and resolve complex, disputed claims * In-depth knowledge of the litigation, arbitration, and trial process * Currently holds or readily can obtain all required adjuster licenses * Ability to identify and use relevant data and metrics to best manage claims * Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency * Ability and willingness to present to senior management and to others in other group settings * Ability to compose summary reports of quality review findings * Ability to obtain vendor compliance to Everest claim department standards * Knowledge of the insurance industry, claims process and legal and regulatory environment The base salary range for this position is $120,000 - $150,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location. All offers include access to a variety of benefits to employees, including health insurance coverage, an employee wellness program, life and disability insurance, 401k match, retirement savings plan, paid holidays and paid time off (PTO). #LI-Hybrid #LI-KG1 What if I don't meet every requirement? At Everest we are dedicated to building an inclusive and authentic workplace. So, if you are excited about this role but your past experience doesn't align perfectly with every element in the job description, we still encourage you to apply. You may be just the right candidate for this or other roles. Please let us know if you need any accommodations throughout the application or interview process. Our Culture At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. * Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Inclusion and Belonging. * Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together. All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve. Type: Regular Time Type: Full time Primary Location: Warren, NJ Additional Locations: Hartford, CT, New York, NY, Philadelphia, PA, Walnut Creek, CA Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************. Everest U.S. Privacy Notice | Everest (everestglobal.com)

Salary Range: $50.42 - $68.08 The Contracts and Legal Claims Specialist oversees contracts management the organization's system. and contract lifecycle, from drafting and preparation to execution; ensuring contractual accountability and duties are met by all parties involved. The role ensures effective administration of the full contract lifecycle, from drafting and review. to execution and compliance monitoring. The Contracts and Legal Claims Specialist is also responsible for coordinating claims and legal matter in collaboration with Vice President, outside legal counsel, insurance carriers and internal stakeholders. The Contracts and Legal Claims Specialist is also responsible for the following duties: Oversite and daily management Management System of the health system's Contract administrative function. Oversite and management of health system policies and numbered memorandums lifecycle with the collaboration stakeholders. on internal Subpoena intake and management for the healthcare system, ensuring timely and accurate response to subpoenas and related data requests and coordinating with legal counsel and internal departments and external vendor to manage the subpoena lifecycle Daily management of the health system's Public Record Request website and coordinate with the appropriate stake holders and legal counsel to ensure compliance with regulatory requirements for responding to requests. Supporting the Vice President and Chief Compliance & Risk Officer with management of litigation claims and other legal matter logistics. Facilitates the claims filing and adjudication process with malpractice carriers and collaborates malpractice carriers with legal counsel and to ensure timely coordination of the discovery process for litigation. Works with legal counsel to coordinate meetings, interviews depositions with and support. staff and medical staff and provides logistical In addition to performing the essential functions listed below, may also be assigned other duties as required. Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 3 **What Is the Opportunity?** Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. The Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. As part of the hiring process, this position will require the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. **What Will You Do?** + Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. + Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision. + Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. + Participate in Telephonic and/or onsite File Reviews. + Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts. + Gather information from policyholders, claimants, witnesses, and third-party providers. + Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. + Maintain accurate records of claim activity in claim management systems. + Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources. + Demonstrate openness to continuous learning, particularly in AI and digital transformation. + Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Previous internship or work experience in insurance, finance, or customer service. + Strong attention to detail and organizational skills. + Ability to manage multiple tasks and prioritize effectively. + Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. + Ability to exercise sound judgement and make effective decisions. + Strong verbal and written communication skills with the ability to convey information clearly and professionally. **What is a Must Have?** + High School Diploma or GED. + One year of customer service experience OR Bachelor's Degree. **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 ******************************************************** .

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

Why Join Stand: At Stand, you'll help build a new class of global property protection. We use advanced physics and AI to model catastrophic risk at the asset level, then automate underwriting and mitigation before loss occurs. Insurance is simply the current delivery mechanism. The real product is a scalable risk engine. We stay when traditional insurers exit. We model what others approximate. And we build systems that change outcomes, not just prices. Background: The property insurance industry is built to price loss after it happens. It relies on coarse proxies, backward-looking data, and manual processes, then accepts damage as unavoidable. Stand takes a different approach. We simulate how real-world catastrophes affect individual properties, translate that into actionable decisions, and automate the business around it. The result is a platform that can underwrite what others can't and operate with far less friction. Role Summary: As Head of Claims at Stand Insurance, you will be responsible for managing the Claims lifecycle, end-to-end in conjunction with third party partners and the Operations team. Unlike many Claims roles, however, this role is unique in that it also provides an opportunity to be part of the solution in avoiding claims before they happen by working with mitigation and retrofitting vendors. By being involved in the building process before, during, and after a claim, you will be able to ensure we are fulfilling our promise of security to insureds in every facet. This role is great for a high energy, execution focused individual with experience in the most challenging property catastrophe markets. Core Responsibilities: Implement catastrophe response program and strategy for various catastrophe perils in conjunction with TPA partners Build core networks for programs such as water remediation, salvage and subrogation, legal defense, and other approved/recommended contractors that can provide high quality repairs for insureds while managing claim expense Maintain Claims compliance in all states and in all functional areas, such as claims handling practices, reporting, OFAC and CMS Medicare compliance, etc. Develop internal and external staffing, partnerships, and scaling Claims department for expansion of states and products Collaborate with cross-functional teams, including underwriting, product, and actuarial, to collaborate on policy language, underwriting guidelines, and claim reserving practices Help develop best in class wind mitigation vendor networks to help support insureds securing appropriate retrofitting quickly and affordably Work with Product and Technology teams to enhance technology for streamlined claim handling processes and create a seamless and transparent claim experience for insureds Must-Haves: 15+ years of property claims experience, predominantly in the personal lines space High-value Homeowners experience Experience in the Florida marketplace is strongly preferred, but generally shall have experience in one or more CATs in a leadership role Comfort working cross-functionally in a fast-paced, entrepreneurial environment Nice-to-Haves: Wildfire catastrophe experience Technical competencies and background in designing/working with teams to develop Claims Management software Compensation: The annual base salary range for full-time employees in this position is $150,000 to $210,000+ meaningful Equity Grant. Compensation decisions are dependent on several factors including, but not limited to, an individual's qualifications, location where the role is to be performed, internal equity, and alignment with market data. Additional Benefits: Comprehensive benefits including above-market Health, Dental, Vision Weekly lunch stipend Flexible time off 1-day a week WFH flexibility 401k plan Equal Opportunity Employment Stand is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status. We believe that diversity enriches the workplace, and we are committed to growing our team with the most talented and passionate people from every community. We are committed to providing reasonable accommodations for qualified individuals. If you require assistance Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Title: Customer Service Claims Processor Department: Customer Service Union: OPEIU 29 Grade: 17 The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims. JD preferred with good interpersonal skills. Call for additional details.

Title: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16 Non-Exempt Hours per Week: 40 The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Possesses a strong work ethic and team player mentality. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third-party administrator. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $25.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

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

ABOUT THE ROLE The Claims Representative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The Claims Representative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards. You will need to be located within 35miles of either plant facility: Vacaville, CA or West Sacramento, CA Three days work from home and two days in office. WHAT YOU'LL DO Claim Intake & Validation Receive, review, and validate incoming warranty claims to determine accuracy and required information. Initiate clarification calls to customers as needed to complete claim details. Maintain accurate claim documentation and communication updates within Dynamics 365 CRM. Claim Management & Resolution Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality. Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction. Host product standards and compliance discussions with customers, helping address concerns professionally and clearly. Administer service reimbursements and prepare settlement letters when applicable. Quality Review & Root Cause Analysis Conduct research to identify root causes of product or service issues. Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements. Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality. Communication & Reporting Prepare clear communications and updates for management regarding claim trends, issues, and opportunities. Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete. Perform additional duties as assigned to support departmental needs. SKILLS & QUALIFICATIONS Strong ability to interpret customer claims and apply relevant warranty coverage. Ability to read and interpret product specifications, drawings, and order confirmations. Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions. Strong verbal and written communication skills with a customer-centric approach. Ability to manage difficult discussions and mitigate customer dissatisfaction effectively. Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly. Strong attention to detail and accuracy in a fast-paced environment. Ability to work independently while supporting team and departmental goals. High curiosity, initiative, and willingness to grow in an evolving environment. WHAT YOU'LL NEED Education: High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education. Experience/Technical Skills: Experience in Ordering/Quoting systems is desired (AccuQuote preferred). Experience with CRM systems is desired. Additional Information All your information will be kept confidential according to EEO guidelines. Why work for Cornerstone Building Brands? Our teams are at the heart of our purpose to positively contribute to the communities where we live, work and play . Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development. *Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement. Cornerstone Building Brands is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster here . You can also view Your Right to Work Poster here along with This Organizations Participation in E-Verify Poster here . If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or [email protected] . If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or [email protected] . This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response. All your information will be kept confidential according to EEO guidelines. California Consumer Privacy Act (CCPA) of 2018 Must be at least 18 years of age to apply. Notice of Recruitment Fraud We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

**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** $94,400.00 - $155,800.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign-on bonus of up to $20,000. This position is hybrid (3 days in office, 2 days remote). Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. **What Will You Do?** + Directly handles assigned severity claims. + Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel as needed. + Directly investigates each claim through prompt and strategically-appropriate 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. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. + Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. + Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. + Maintains claim files and documents claim file activities in accordance with established procedures. + Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively creates Claim File Analysis (CFA) by adhering to quality standards. + Utilizes diary management system to ensure that all claims are handled timely. + At required time intervals, evaluate liability & damages exposure. + Establishes and maintains proper indemnity and expense reserves. + Recommends appropriate cases for discussion at roundtable. + Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. + Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. + Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. + Develops and employ creative resolution strategies. + Responsible for prompt and proper disposition of all claims within delegated authority. + Negotiates disposition of claims with insureds and claimants or their legal representatives. + Recognizes and implements alternate means of resolution. + Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. + Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, + Tracks and controls legal expenses to assure cost-effective resolution. + Effectively and efficiently manage both allocated and unallocated loss adjustment expenses. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + 5 years equivalent business experience. + Advanced level knowledge and skill in claim and litigation. + Basic working level knowledge and skill in various business line products. + Strong negotiation and customer service skills. + Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. + Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. + Able to make independent decisions on most assigned cases without involvement of supervisor. + Openness to the ideas and expertise of others actively solicits input and shares ideas. + Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices. + Demonstrated coaching, influence and persuasion skills. + Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. + Can adapt to and support cultural change. + Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. + Analytical Thinking - Advanced. + Judgment/Decision Making - Advanced. + Communication - Advanced. + Negotiation - Advanced. + Insurance Contract. + Knowledge - Advanced. + Principles of Investigation - Advanced. + Value Determination - Advanced. + Settlement Techniques - Advanced. + Legal Knowledge - Advanced. + Medical Knowledge - Intermediate. **What is a Must Have?** + High School Degree or GED. + 3 years of liability claim handling experience and/or comparable litigation claim experience. + In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. + Generally, license(s) are required to be obtained within three months of starting the job. **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 ******************************************************** .

Title: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16 Non-Exempt Hours per Week: 40 The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability. May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Possesses a strong work ethic and team player mentality. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third-party administrator. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $25.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Job Description ABOUT THE ROLE The Claims Representative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The Claims Representative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards. You will need to be located within 35miles of either plant facility: Vacaville, CA or West Sacramento, CA Three days work from home and two days in office. WHAT YOU'LL DO Claim Intake & Validation Receive, review, and validate incoming warranty claims to determine accuracy and required information. Initiate clarification calls to customers as needed to complete claim details. Maintain accurate claim documentation and communication updates within Dynamics 365 CRM. Claim Management & Resolution Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality. Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction. Host product standards and compliance discussions with customers, helping address concerns professionally and clearly. Administer service reimbursements and prepare settlement letters when applicable. Quality Review & Root Cause Analysis Conduct research to identify root causes of product or service issues. Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements. Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality. Communication & Reporting Prepare clear communications and updates for management regarding claim trends, issues, and opportunities. Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete. Perform additional duties as assigned to support departmental needs. SKILLS & QUALIFICATIONS Strong ability to interpret customer claims and apply relevant warranty coverage. Ability to read and interpret product specifications, drawings, and order confirmations. Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions. Strong verbal and written communication skills with a customer-centric approach. Ability to manage difficult discussions and mitigate customer dissatisfaction effectively. Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly. Strong attention to detail and accuracy in a fast-paced environment. Ability to work independently while supporting team and departmental goals. High curiosity, initiative, and willingness to grow in an evolving environment. WHAT YOU'LL NEED Education: High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education. Experience/Technical Skills: Experience in Ordering/Quoting systems is desired (AccuQuote preferred). Experience with CRM systems is desired. Additional Information All your information will be kept confidential according to EEO guidelines. Why work for Cornerstone Building Brands? Our teams are at the heart of our purpose to positively contribute to the communities where we live, work and play. Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development. *Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement. Cornerstone Building Brands is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster here. You can also view Your Right to Work Poster here along with This Organizations Participation in E-Verify Poster here. If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or *******************************. If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or *******************************. This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response. All your information will be kept confidential according to EEO guidelines. California Consumer Privacy Act (CCPA) of 2018 Must be at least 18 years of age to apply. Notice of Recruitment Fraud We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.