Claim specialist jobs in Boise, ID - 42 jobs

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

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. Follow claims handling procedures and participate in claim negotiations and settlements. Deliver a high level of customer service to our agents, insureds, and others. Devise alternative approaches to provide appropriate service, dependent upon the circumstances. Meet with people involved with claims, sometimes outside of our office environment. Handle investigations by telephone, email, mail, and on-site investigations. Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. Assist in the evaluation and selection of outside counsel. Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience A minimum of three years of insurance claims related experience. The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. The ability to effectively understand, interpret and communicate policy language. The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-CH1 #LI-Hybrid

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Sr. Claims Specialist, Professional Liability | Medical Malpractice **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **TAKING CARE OF YOU BY** + We offer a diverse and comprehensive benefits package including: + Three Medical, and two dental plans to choose from. + Tuition reimbursement eligible. + 401K plan that matches 50% on every $ you put in up to the first 6% you save. + 4 weeks PTO your first full year. **NEXT STEPS** If your application is selected to advance to the next round, a recruiter will be in touch. _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 $100,000 - $110,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

The Claims Adjuster is responsible for managing workers compensation claims and assisting the process of determining benefits due the injured worker, ensure ongoing adjudication of claims within company standards and industry best practices and comply with all statutory and regulatory requirements for the administration of workers compensation benefits on behalf of the Company. KEY RESPONSIBILITIES AND ESSENTIAL FUNCTIONS: New Claims: All new lost time claims require an initial contact with the employer, the injured worker and the medical provider. This must be done within 24 hours of receipt of the claim or notification of a claim. Ensure that all claim determinations and payments are completed timely including but not limited to, acceptance/denial letters, wage determination letters including required enclosures and appeal forms. In jurisdictions requiring the letters be provided in Spanish and English the adjuster is responsible to make sure all letters are completed. The initial payment of TTD is to be completed within 14 days from the receipt of an accepted claim. Wage information is to be solicited from the employer and either an average weekly wage or average monthly (jurisdiction dependent) be established. In the event actual payroll documentation cannot be obtained from the employer an “estimated wage” is established and a payment reconciliation is done when the verified wage is secured. Initial compensation benefits should NOT be delayed due to the failure of the employer to provide wage documentation. Timely claims determinations for all services including but not limited to: acceptance, denials, authorizations for treatment, benefit payment start, termination are to be included within the statutory or regulatory time frames of the jurisdiction. Denials requiring certified mailing are to be completed timely with appropriate tracking. Regulatory notices are to be completed timely when required by jurisdictions. Approvals and denials of medical bills should be completed within 24 hours of receipt so bills can be repriced and paid timely. Identify the medical providers and medical treatment plan and ensure timely and appropriate medical care is provided to the injured worker. In cases requiring complex or unusual medical care a nurse case manager is to be assigned to facilitate the timely and appropriate care. All communications with all parties and reference to all determinations and correspondence are to be included in the claim notes. Each office is “paperless” offices, and all documents need to be scanned and added to the claim claims system and a claim note generated. Manage the legal aspects of the claim and appropriately assign and direct designated attorneys. Assign claims for investigations, including surveillance, medical surveys and social media checks when required and seek supervisor support on related questions. Ensure that all bills for various expenses, including legal bills, managed care bills and similar expenses are paid timely or direct claims assistants to pay such when appropriate. Answer phone calls immediately when in the office. Return all calls and voice mail messages within 24 hrs. Respond to all e-mails when required within 24 hrs. Direct claims assistants to facilitate adjuster assignments as required. This includes directing clerical staff in duties such as copying documents, scheduling medical appointments for injured workers and filing of documents. Coordinate assignments with the supervisor of the assistants. Monitor claims for reinsurance/excess insurance reporting and provide initial reports and quarterly updates on all claims meeting reporting requirements. Performs other activities, assignments and duties as assigned. Requirements QUALIFICATIONS: High school diploma or GED required Bachelor's degree or equivalent experience preferred 2-3 years' claims experience preferred Insurance industry knowledge preferred Excellent analytical skills and verbal and written communication skills Strong organizational skills Strong oral and written communication skills Salary Description $55,000 - $65,000

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. **Required Qualifications** - New York Independent Adjuster License - Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience - DG system knowledge **Education** **-** High School Diploma required - Preferred Associates degree or equivalent work experience. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 02/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Sign-On Bonus Opportunity of up to $4,000* Pay Range: $45000 - $110000 / year Our Perks & Benefits: * Unlimited/uncapped commission - your earning potential is in your hands * Lucrative incentive sales plans, bonuses and sales contests to recognize your success * No cold calling - we provide a high volume of inbound leads and walk in traffic * Comprehensive paid training and licensing, plus on-going mentorship and development * Recognition-focused culture that celebrates your achievements * Comprehensive benefits package including medical, dental, vision and life insurance * Paid time off to recharge and maintain a healthy work-life balance * Retirement Plan (401k) with company-matched contributions * Fitness Reimbursement - up to $15/month for gym memberships * Employee Assistance Program - confidential support for personal or professional challenges at no cost * Extra Perks - optional plans for disability, hospital indemnity, health advocate program, universal life, critical illness, accident insurance, and even pet insurance Our Company: Confie and its family of companies - Freeway, Baja, Bluefire & others - is one of the largest privately held insurance brokers in the United States. We have been ranked the #1 Personal Lines Leader by the Insurance Journal for eight consecutive years! With more than 800 retail locations nationwide, we are committed to helping our employees take their careers and income potential to new heights. We are proactively looking for bright, motivated, and goal-oriented individuals who are excited about career advancement. Come Grow With Us! What You Will Do: As a Homeowners Insurance Specialist, your primary responsibility will be helping individuals and families protect their most valuable asset - their home. You will focus exclusively on selling and servicing homeowners insurance policies, guiding customers through coverage options, and building long-term relationships based on trust and expertise. This role provides the opportunity to grow your earnings, establish yourself as a subject matter expert, and be rewarded for your success * Manage Policies: Oversee new homeowners insurance policies, renewals, endorsements, and supplemental (DIC or wrap-around) coverage to ensure complete client protection. * Negotiate & Ensure Compliance: Secure competitive quotes, negotiate with multiple carriers - including expertise with any state available programs (i.e., California Fair Plan) - and maintain full compliance and documentation standards. * Develop Referral Networks: Build and sustain a strong network of referral partners (contractors, real estate professionals, public adjusters, etc) to drive consistent new business growth. * Build & Retain Clients: Grow a loyal book of business through exceptional service, proactive communication, and clear education on coverage options. * Consult with Expertise: Guide clients through policy details - terms, coverages, exclusions, and premiums - ensuring they understand their choices and feel confident in their protection. * Achieve Results: Meet and exceed sales and retention goals while tracking key performance metrics and providing regular reporting. The Perfect Match: * A Personal Lines or Property and Casualty license * Bilingual skills in English and Spanish (a strong plus) * 2+ years of experience in homeowners / property insurance (sales, servicing, underwriting or policy quoting) * A High School Diploma or GED * Strong ability to build customer relationships and earn trust * Excellent follow-up, organization, and multi-tasking skills * An ambitious, motivated attitude with a desire for growth and advancement * Strong written and verbal communication skills As permitted by applicable law and from time-to-time, Confie may use a computer system that has elements of artificial intelligence to help make decisions about your employment, including recruitment, hiring, renewal of employment, or the terms and conditions of your employment. Employees with questions about Confie's use of these computer systems should contact Human Resources at **************************** Insurance Sales Homeowners Insurance Agent Hiring Immediately Acceptance Insurance Freeway Auto Insurance

Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. Candidates should be based in California with California Self-Insured Certification or based in West Region with experience in handling Alaska Workers Compensation claims. The salary range posted reflects the range for the varying pay scale that encompasses each of the Liberty Mutual regions and the overall cost of living for that region. Responsibilities * Investigates claims to determine whether coverage is provided, establish compensability and verify exposure. * Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority. * Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management. * Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols. * Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely. * Identifies and appropriately handles claims with third party subrogation potential, SIF (Self-Insured Fund) and MSA (Medicare Set Aside) exposure. * Establishes and maintains accurate reserves on all assigned files. * Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority. * Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds. * Demonstrates the ability to understand new and unique exposures and coverages. * Demonstrates the ability to understand key data elements and claims related data analysis. * Confers directly with policyholders on coverage and resolution strategy issues. * Coordinates and participates in training sessions for less experienced staff, including both Complex Non-Complex staff. Qualifications * A bachelor's degree or equivalent business experience is required * In addition, the candidate will generally possess 5-7 years of related claims experience with 1-2 years of experience in complex claims * Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skills required About Us 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. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. 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 * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-CH1 #LI-DNP #LI-Onsite

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Specialist, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents Company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors assigned staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. **Experience** Six (6) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **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_ **_$117,000 - $125,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI #IN-DNI

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. - QNXT, Salesforce and basic SQL To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Representative (IAP) - Workers Compensation Training Program Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? + A stable and consistent work environment in an office setting. + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities. + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. **ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Attendance and completion of designated classroom claims professional training program. + Performs on-the-job training activities including: + Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. + Adjusting low and mid-level liability and/or physical damage claims under close supervision. + Processing disability claims of minimal disability duration under close supervision. + Documenting claims files and properly coding claim activity. + Communicating claim action/processing with claimant and client. + Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. + Participates in rotational assignments to provide temporary support for office needs. **QUALIFICATIONS** Bachelor's or Associate's degree from an accredited college or university preferred. **EXPERIENCE** Prior education, experience, or knowledge of: - Customer Service - Data Entry - Medical Terminology (preferred) - Computer Recordkeeping programs (preferred) - Prior claims experience (preferred) Additional helpful experience: - State license if required (SIP, Property and Liability, Disability, etc.) - WCCA/WCCP or similar designations - For internal colleagues, completion of the Sedgwick Claims Progression Program **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum + An assigned mentor and manager that will support and guide you on your career journey + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more _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 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to: Investigate, evaluate, and settle entry-level insurance claims Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products Learn and comply with Company claim handling procedures Develop entry-level claim negotiation and settlement skills Build skills to effectively serve the needs of agents, insureds, and others Meet and communicate with claimants, legal counsel, and third-parties Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements Desired Skills & Experience Bachelor's degree or direct equivalent experience with property/casualty claims handling Ability to organize data, multi-task and make decisions independently Above average communication skills (written and verbal) Ability to write reports and compose correspondence Ability to resolve complex issues Ability to maintain confidentially and data security Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Continually develop product knowledge through participation in approved educational programs Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNI #IN-DNI